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背景与目的儿童青少年B细胞非霍奇金淋巴瘤(Bcellnon-Hodgkinslymphoma,B-NHL)恶性程度高、进展快、早期患者对常规CHOP方案化疗可获得较好疗效,但晚期患者疗效差。对不同分期的患者应如何治疗值得进一步探索。本文回顾性分析和比较CHOP、CHOP+HD-MTX和德国BFM-90方案治疗儿童青少年B-NHL的疗效、不良反应和生存率。方法CHOP方案组30例3～17岁初治的B-NHL患者,Ⅰ/Ⅱ期13例,Ⅲ/Ⅳ期(StJude分期)17例,均接受2～8疗程常规CHOP方案化疗,每3周重复。CHOP+HD-MTX组18例3～14岁初治的B-NHL患者,Ⅰ/Ⅱ期6例,Ⅲ/Ⅳ期(StJude分期)12例,均接受2～8疗程CHOP+HD-MTX方案化疗和鞘注,每4周重复。BFM-90方案组25例1.5～15岁的初治的B-NHL患者,Ⅱ期7例,Ⅲ/Ⅳ期(StJude分期)18例,均接受NHL-BFM-90方案化疗。Ⅰ/Ⅱ期患者接受A和B疗程交替化疗共4～6疗程;Ⅲ/Ⅳ期患者接受AA和BB疗程交替化疗共6疗程,每疗程间隔18～21天。结果CHOP组21例(70%)完全缓解(completeresponse,CR),4例(13%)部分缓解(partialresponse,PR);有20%的疗程发生Ⅲ/Ⅳ级血液毒性。CHOP+HD-MTX组15例(83%)CR,3例(16%)PR;有52%疗程发生Ⅲ/Ⅳ级血液毒性。BFM-90方案组24例(96%)CR,1例(4%)PR;Ⅲ/Ⅳ级血液毒性A疗程57%,B疗程60%,AA疗程91%,BB疗程76%;AA疗程的血液
BACKGROUND & OBJECTIVE: Bcellnon-Hodgkinslymphoma (B-NHL) has a high degree of malignancy and rapid progression in children and adolescents. Early patients have better curative effect on conventional CHOP chemotherapy but poor efficacy in patients with advanced disease. How to treat patients with different stages is worth further exploration. This paper retrospectively analyzed and compared the efficacy, adverse reactions and survival rates of CHOP, CHOP + HD-MTX and German BFM-90 regimen in children and adolescents with B-NHL. Methods Thirty patients with B-NHL who were initially treated at the age of 3 to 17 years, 13 cases of stage Ⅰ / Ⅱ and 17 cases of stage Ⅲ / Ⅳ (StJude staging) were enrolled in the CHOP regimen. All patients received conventional CHOP regimen of 2-8 cycles and repeated every 3 weeks . In the CHOP + HD-MTX group, 18 B-NHL patients aged 3-14 years, 6 patients in stage I / II and 12 patients in stage III / IV (StJude staging) received CHOP + HD-MTX regimen And sheath injection, repeated every 4 weeks. BFM-90 regimen included 25 patients with untreated B-NHL from 1.5 to 15 years old, and 7 patients in stage II and 18 patients in stage III / IV (StJude staging) received NHL-BFM-90 regimen. Stage I / II patients underwent alternating chemotherapy with A and B regimens for a total of 4 to 6 cycles; patients in stage III / IV received alternating cycles of AA and BB cycles for a total of 6 cycles of 18 to 21 days. Results In the CHOP group, complete response (CR) was achieved in 21 patients (70%) and partial response (PR) in 4 patients (13%). Grade Ⅲ / Ⅳ hematotoxicity occurred in 20% of the patients in the CHOP group. Fifteen patients (83%) had CR and three patients (16%) had PR in CHOP + HD-MTX group. Grade Ⅲ / Ⅳ hematotoxicity occurred in 52% of the patients. In the BFM-90 regimen, 24 patients (96%) had CR and 1 patient (4%) had PR. The grade Ⅲ / Ⅳ hematotoxic A treatment was 57%, the B treatment 60%, the AA treatment 91% and the BB treatment 76% blood