Objective To evaluate the effectiveness and safety of chemotherapy regimens represented by pirarubicin (THP) vs. adriamycin hydrochloride (ADM) for non-Hodgkin lymphoma (NHL) in mainland China. Methods The randomized controlled trials (RCTs) about THP vs. ADM for treating NHL were collected in the databases such as CNKI, CBM, VIP and WanFang Data, and the references of the included studies were also retrieved manually, with the retrieval time from January 1989 to September 2012. According to the inclusion and exclusion criteria, two reviewers independently screened articles, extracted data, and assessed the methodological quality of the included studies. Then meta-analysis was performed using RevMan 5.0 software. Results A total of 15 RCTs involving 1 659 patients were included. The results of meta-analysis showed that: a) As for the total effective rate, the CTOP (C: cyclophosphamide, T: pirarubicin, O: vincristine, P: prednison) regimen was superior to the CHOP (C: cyclophosphamide H: adriamycin hydrochloride, O: vincristine, P: prednison) regimen with a significant difference (OR=1.07, 95%CI 1.02 to 1.12, P=0.006); and b) As for the safety, there were significant differences between the two groups in the incidence of cardiac toxicity (OR=0.42, 95%CI 0.30 to 0.57, Plt;0.000 01), gastrointestinal tract response (OR=0.69, 95%CI 0.56 to 0.85, P=0.000 5) and liver damage (OR=0.69, 95%CI 0.48 to 1.00, P=0.05). But no significant differences were found between the two groups in the incidence of mye1osuppression: the decreased hemoglobin (OR=0.83, 95%CI 0.61 to 1.14, P=0.25), leucopenia (OR=0.85, 95%CI 0.68 to 1.07, P=0.17), and thrombocytopenia (OR=0.99, 95%CI 0.70 to 1.39, P=0.95). Conclusion Based on the domestic evidences at current and compared with CHOP regimen represented by ADM, CTOP regimen represented by THP for treating NHL shows a higher total effective rate and less side effects. However, more high quality, large sample and double blind RCTs are required to prove this conclusion for the quality and quantity limitation of the included studies.
Objective To systematically evaluate the pharmacoeconomic vaule of chemotherapy combined with rituximab for patients with non-Hodgkin’s lymphomas (NHL). Methods A systematic literature search of cost-effectiveness studies on rituximab treating NHL published from 1998 to 2012 was carried out in following databases: PubMed, ScienceDirect, Health Technology Assessment (HTA) and Cochrane Database of Systematic Reviews (CDSR). And the references of included studies were also retrieved manually. The studies were screened according to the pre-designed inclusion and exclusion criteria, and the incremental cost- effectiveness ratio (ICER) in comparison between chemotherapy plus rituximab and chemotherapy alone was systematically evaluated according to the literature evaluation index system. Results The average ICER of Rituximab treating NHL was 16 318/QALY, 17 688/QALY, and 22 461/QALY in the UK, Mainland Europe, and US, respectively. All the reported ICERs in the included studies were below the implemented country-specific thresholds. Conclusion Based on present foreign literature, the integrated therapy of chemotherapy and rituximab for NHL is supposed to be a better cost-effective therapy with ICER below the implemented country-specific thresholds.
Objective To evaluate the relationship between body mass index (BMI) and malignant lymphoma by means of Meta-analysis. Methods Such databases as Web of Science, PubMed, EBbase, CNKI, Wanfang, VIP and CBM were searched from the date of their establishment to April 2011 to collect the case control studies on the relationship between BMI and malignant lymphoma. Two researchers independently selected studies, extracted data and assessed the quality according to the inclusive and exclusive criteria, and then conducted Meta-analyses by using RevMan5.0 software for heterogeneity test and pooled OR calculation. Results Seven case control studies involving 8416 malignant lymphoma patients and 14760 other patients were included. The quality of all studies scored 4, indicating reliable quality. Meta-analyses of the low BMI, overweight and obesity population were OR=0.8, 95%CI 0.79 to 0.95, P=0.003; OR=1.04, 95%CI 0.98 to 1.11, P=0.16; and OR=1.22 95%CI 1.04 to 1.43, P=0.01, respectively. The stratified Meta-analysis on histological subtypes showed that obesity was associated with a significantly increased risk of diffuse large B cell lymphoma (OR=1.33 95%CI 1.18 to 1.50, Plt;0.000 01), but was not associated with the follicular lymphoma or small lymphocytic lymphoma/chronic lymphocytic leukemia. Conclusion These findings demonstrate that low BMI is associated with the decrease of malignant lymphoma, and obesity is an increasing risk of malignant lymphoma, especially, the diffuse large B cell lymphoma.
目的 增加对治疗相关性继发白血病的认识。 方法 报道非霍奇金淋巴瘤治疗后2年继发急性髓细胞白血病M6型1例，结合文献讨论治疗相关性白血病的发病机制、治疗、预后。 结果 1例73岁非霍奇金淋巴瘤患者接受R（Rituxmab，利妥昔单抗）－CHOP环磷酰胺+多柔比星+长春新碱+泼尼松方案规律化学治疗。治疗结束24+个月后，经骨髓涂片及细胞免疫分型诊断为急性髓细胞白血病M6型，染色体检查为：44～48，XY，del（5）（q12q33），-8，-10，der（12）t（4；12）（q11-q12；p13），其一般情况急剧恶化并死亡。 结论 治疗相关性白血病的发生可能与烷化剂等化疗药物使用和免疫受损等有关，利妥昔单抗导致第二肿瘤的发生暂时不能除外。治疗相关性白血病常伴有复杂染色体核型，其病情发展迅速，治疗效果差，生存期明显缩短。Objective To improve the understanding of secondary therapy-related leukemia. Methods The clinical data of one patient with non-Hodgkin lymphoma which transformed into acute myeloid leukemia M6 2 years after chemotherapy were studied. We discussed the pathogenesis, treatment and prognosis of therapy-related leukemia with literature review. Results A 73-year-old patient diagnosed to have non-Hodgkin’s lymphoma accepted R-CHOP chemotherapy.Two years after the treatment, the disease finally developed into acute myeloid leukemia M6 confirmed by cytogenetics, bone marrow morphology and flowcytometry analysis. The chromosome analysis demonstrated complex karyotypes as 44-48, XY, del (5) (q12q33), -8, -10, der (12) t (4; 12) (q11-q12; p13). His general status deteriorated rapidly and soon after the patient died. Conclusions Occurrence of therapy-related leukemia may be due to the administration of alkylating agents, topoisomerase inhibitors and damage of immune function. Therapy-related leukemia often occurs with complex karyotypes and progresses rapidly with poor treatment response.
【摘要】 目的 探讨自体造血干细胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）治疗侵袭性NK/T细胞淋巴瘤的疗效。 方法 对我科2005年1月16日收治的1例侵袭性NK/T细胞淋巴瘤患者的造血干细胞移植和随访资料进行回顾性分析，并复习国内外相关文献。 结果 患者为37岁女性，诊断结外鼻型NK/T细胞淋巴瘤，系统性，经CHOAP和ICE方案化学疗法、手术、局部放射治疗控制病情良好后，采集自体骨髓造血干细胞，行auto-HSCT，预处理方案为全身放射治疗+ECy；移植+29 d造血功能即顺利重建；移植后密切随访，患者一直处于完全缓解，至今已存活67个月。 结论 auto-HSCT治疗侵袭性NK/T细胞淋巴瘤疗效肯定、可靠。【Abstract】 Objective To explore the therapeutic effect of autologous hematopoietic stem cell transplantation (auto-HSCT) on aggressive NK/T lymphoma. Methods The clinical data of one patient with aggressive NK/T lymphoma diagnosed in January 2005 were retrospectively analyzed, and the relevant domestic literatures were analyzed. Results This thirty-seven-year-old female patient had good disease control after undergoing chemotherapy with CHOAP and ICE regimens, surgery, and locoregional radiotherapy. After that, she had been collected enough bone marrow-derived hematopoietic stem cells, then underwent auto-HSCT with these cells. The conditioning regimen was TBI plus ECy. On the +29th day after transplantation,the hematopoietic reconstruction was successful. During the follow-up period, the patient was in complete remission status all along and her disease-free survival (DFS) was 67 months. Conclusion Auto-HSCT is effective on aggressive NK/T lymphoma.
【摘要】 目的 探讨对自体造血干细胞移植（autologous hematopoietic stem cell transplantation，auto-HSCT）后复发的非霍奇金淋巴瘤患者再进行异基因造血干细胞移植（allogeneic hematopoietic stem cell transplantation，allo-HSCT）治疗的临床疗效。 方法 收集2000年1月-2010年12月难治性恶性淋巴瘤采用auto-HSCT后复发患者11例，病程27个月~6.5年。所有患者在auto-HSCT前均为复发难治性病例，auto-HSCT后，完全缓解8例，部分缓解3例，自体移植后中位复发时间15个月，患者复发后采用异基因亲缘造血干细胞移植，人类白细胞抗原（human leukocyte antigen，HLA）全相合（6/6）6例，5/6相合3例，4/6相合2例；性别相同6例，性别不同5例。预处理方案为FBC方案，即氟达拉滨30 mg/m2 1~5 d，白消安12~14 mg/kg分4 d口服，环磷酰胺120 mg/kg分2 d使用。移植物均为外周血造血干细胞加骨髓。移植物抗宿主病（graft-versus-host disease，GVHD）的预防：HLA全相合采用环孢素+短程甲氨蝶呤+吗替麦考酚酯，不全相合采用抗胸腺细胞球蛋白+环孢素+短程甲氨蝶呤+吗替麦考酚酯。 结果 11例患者全部获得造血重建，急性GVHD发生6例（54.55%），其中Ⅰ度、Ⅱ度4例，Ⅲ度、Ⅳ度各1例；1例Ⅳ度GVHD因合并感染死亡，5例均得到有效控制；发生慢性GVHD 7例（63.64%），其中有2例急性GVHD转为慢性，4例局限型，3例广泛型。随访8个月~9年，有4例分别于移植后8、15、21、34个月疾病复发，另外6例仍生存。 结论 allo-HSCT对于auto-HSCT后复发的非霍奇金淋巴瘤患者仍是一种有效的挽救性治疗手段。【Abstract】 Objective To explore the clinical efficacy of allogeneic hematopoietic stem cell transplantation (allo-HSCT) on relapsing non-Hodgkin′s lymphoma after autologous stem cell transplantation (auto-HSCT). Methods The clinical data of 11 patients with recurrent non-Hodgkin′s lymphoma after auto-HSCT from January 2000 to December 2010 were collected, including nine males and 2 females with the median age of 39 years (13-48 years old), and the median duration of the disease was 3 years (27 months-6.5 years). All patients were relapsed or refractory cases. After auto-HSCT, complete remission was found in 8 and partial remission was in 3. The recurrence median time after auto-HSCT was 15 months. The patients underwent allo-HSCT after the recurrence of the disease. In the 11 patients, human leukocyte antigen (HLA) full matched (6/6) in 6, 5/6 matched in 3, and 4/6 matched in 2; the same gender in 6 and different gender in 5. FBC conditioning regimen: fludarabine 30 mg/m2 for 1-5 days, BU 12-14 mg/kg in 4 days of oral, CY 120 mg/kg in 2 days. Grafts are peripheral blood stem cells plus bone marrow. Prevention of graft-versus-host disease (GVHD): HLA full-matched by CsA+short-term MTX+MMF and mismatched by ATG+CsA+short-term MTX+MMF. Results All of the 11 patients received hematopoietic reconstruction, acute GVHD occurred in 6 cases (54.55%), including degree Ⅰ plus Ⅱ in 4, degree Ⅲ in 1 and degree Ⅳ in 1. One patient died of infection due to degree Ⅳ GVHD, and the rest had been effectively controlled. Chronic GVHD occurred in 7 patients (63.64%); limited type was in 4 in and extensive type was in 3. During the follow-up period of 8 months-9 years, 4 patients relapsed 8, 15, 21, and 34 months after transplantation, and the other 6 patients was still alive. Conclusion Allo-HSCT is effective on relapsing non-Hodgkin′s lymphoma after auto-HSCT.
目的:探讨肾脏原发性非霍奇金淋巴瘤(PNHL)的临床表现,诊治及预后特点。方法:总结我院自2000~2007年诊治的5例肾脏PNHL患者临床资料,5例患者术前均诊断为原发性肾癌。均行手术治疗,术后病理检查证实为非霍奇金淋巴瘤。 结果:拒绝化疗的患者于术后4个月死亡,一例73岁的高龄患者术后14个月死于化疗毒副反应,其余三例患者随访到现在,均无病生存。 结论:该病术前诊断困难,与原发性肾癌容易混淆,肾图对诊断该病或可提供一定参考价值。对该类肿瘤给予根治性切除,术后给予正确及时的个体化化疗可以获得较好的治疗效果,部分患者甚至可以长期无病生存。
ObjectiveTo evaluate the effects of CTX, EADM, VCR, and Pred (CHOP) as preoperative regional intra-arterial infusion chemotherapy in primary gastric malignant lymphoma (PGML). MethodsForty-one patients with PGML underwent preoperative regionalarterial infusion chemotherapy. The regimen consisting of CTX 600 mg/m2, EADM 50 mg/m2, VCR 1.4 mg/m2, and Pred 60 mg/m2, was administrated 14－21 d before operation. Another 33 patients with similar PGML during the same period underwent surgery directly. The response of the tumor and chemotherapy toxicity were observed, together with the survival of the cases. ResultsAmong the 33 patients undergoing surgery directly, 24 cases (72.7%) had curative resection, the 5-year survival rate was 58.3% (14/24). All 41 patients of the neoadjuvant chemotherapy group completed the planned regimen of chemotherapy and surgery successfully. The most common related adverse effects were grade Ⅰ-Ⅱ gastrointestinal discomfort (22 cases) and bone marrow suppression (14 cases). Thirtyseven cases (90.2%) underwent curative resection, the 5year survival rate was 67.7% (21/31). There was no significant difference between two groups in 5year survival rate (χ2=0.517， P＝0.471), while with significant difference in curative resection rate (P＝0.041). ConclusionsNeoadjuvant intra-arterial infusion chemotherapy (CHOP) has been wellrated; it appears to have improved the resectable rate of the PGML patients studied.
目的了解甲状腺原发性恶性淋巴瘤的特点，探讨其诊治方法。方法回顾分析我院收治的7例甲状腺原发性恶性淋巴瘤患者的临床表现，血清抗甲状腺球蛋白抗体（TGA）,抗甲状腺微粒体抗体（TMA），B超，核素扫描，病理组织学及免疫组织化学染色特点。结果7例患者均行手术切除和术后化疗，病理石蜡切片证实为甲状腺原发性恶性淋巴瘤，免疫组化染色显示白细胞共同抗原阳性，细胞角蛋白阴性，支持本诊断。治疗后随访4个月～11年患者均生存。结论病理检查是明确诊断的可靠依据，手术应尽可能切除肿瘤，术后予以化疗，治疗效果较为满意。