Akbulut H, Soykan I, Yakaryilmaz F, Icii F, Aksoy F, Haznedaroglu S, Yildirim S
Department of Medical Oncology, Ibn-i Sina Hospital, Ankara University School of Medicine, Sihhiye-Ankara, Turkey.
Cancer. 1997 Jul 1;80(1):8-14. doi: 10.1002/(sici)1097-0142(19970701)80:1<8::aid-cncr2>3.0.co;2-t.
Currently, there is no agreement regarding optimal treatment strategies for immunoproliferative small intestinal disease (IPSID). In this article, the authors report the treatment outcomes of a group of 23 Turkish patients with IPSID.
Between December 1988 and July 1993, 23 consecutive patients with IPSID, including 5 with secretory type, were included in the study. Seven patients with Stage A disease (according to the criteria of Galien et al.) received tetracycline (1 g/day, orally) for a median duration of 7 months (range, 6-11 months) initially, whereas the remaining patients (9 Stage B patients and 7 Stage C patients) received combination chemotherapy (cyclophosphamide, vincristine, procarbazine, and prednisolone [COPP regimen]) followed by tetracycline at a dose of 1 g/day for 6 more months in patients with complete response (CR) after the COPP regimen.
The median follow-up was 68 months (range, 38-89 months). As first-line therapy in Stage A patients, tetracycline yielded a 71% CR and 43% disease free survival (DFS) rate. Eleven of 16 patients (69%) with Stage B or C disease who received the COPP regimen achieved CR and only 2 patients had a recurrence (DFS rate of 56%). The 5-year overall survival (OAS) rate for the entire group was 70%, and the 5-year DFS rate for patients with CR was 75%. However, the median OAS for 3 patients with immunoblastic lymphoma was only 7 months.
The COPP regimen, with its acceptable toxicity, appears to be a good alternative as a first-line treatment for patients with Stage B or C IPSID with low grade lymphoma whereas tetracycline appears to be the initial treatment of choice for patients with Stage A disease.
目前，关于免疫增殖性小肠疾病（IPSID）的最佳治疗策略尚无共识。在本文中，作者报告了一组23例土耳其IPSID患者的治疗结果。
1988年12月至1993年7月，连续纳入23例IPSID患者，其中5例为分泌型。7例A期疾病患者（根据加利安等人的标准）最初接受四环素治疗（口服1克/天），中位疗程为7个月（范围6 - 11个月），其余患者（9例B期患者和7例C期患者）接受联合化疗（环磷酰胺、长春新碱、丙卡巴肼和泼尼松龙[COPP方案]），COPP方案治疗后完全缓解（CR）的患者再接受6个月的四环素治疗，剂量为1克/天。
中位随访时间为68个月（范围38 - 89个月）。作为A期患者的一线治疗，四环素的CR率为71%，无病生存率（DFS）为43%。接受COPP方案的16例B期或C期疾病患者中有11例（69%）达到CR，仅2例复发（DFS率为56%）。整个组的5年总生存率（OAS）为70%，CR患者的5年DFS率为75%。然而，3例免疫母细胞淋巴瘤患者的中位OAS仅为7个月。
COPP方案毒性可接受，似乎是B期或C期低度淋巴瘤IPSID患者一线治疗的良好选择，而四环素似乎是A期疾病患者的初始治疗选择。
