DICE方案治疗97例复发／难治非霍奇金淋巴瘤患者的疗效及生存分析

OBJECTIVE: To investigate the efficacy and survival of the DICE regimen (cisplatin, ifosfamide, etoposide, dexamethasone) for relapsed and refractory NHL. METHODS: Clinical data of 97 relapsed and refractory NHL patients treated with DICE regimen in Peking University Cancer Hospital between Sep 1. 2008 and Dec 31. 2013 were retrospectively analyzed, and then we evaluate the efficacy and safety of DICE regimen. RESULTS: ①There were 64 males and 33 females with a median age of 49 years. The most common pathological type was DLBCL (73.20%). There were 35 B-NHL patients used rituximab combined with DICE. Finally, a total of 26 patients underwent autologous stem cell transplantation (auto-HSCT) after the salvage chemotherapy. ②The overall response rate (ORR) was 47.42%, the complete response (CR) rate was 22.68%. The ORR of the relapsed/progressive group was higher than the refractory group [67.57% (25/37) vs 35.00% (21/60), χ(2)= 9.736, P=0.002]. ③The median follow-up of these 97 patients was 15.0 months (1.5–80.0 months). The expected median progression-free survival (PFS) and overall survival (OS) was 12.0 (95% CI 5.0–19.0) months, 26.0 (95% CI 6.0–45.9) months. ④There was no difference between the auto-HSCT group and no auto-HSCT group in the median OS [41.0 (95%CI 8.9–73.1) vs 22.0 (95%CI 8.5–35.5) months, P=0.361]. The patients who achieved CR and PR after DICE regimen had longer OS than those patients who in stable or progressive disease (56.0 vs 18.5 months, P <0.001). Patients who used DICE combined with rituximab had longer OS than patients who only used DICE regimen (51.5 vs 28.5 months, P=0.041). The multiple-factor analysis showed that the efficacy of DICE was an independent prognostic factor of OS [HR=4.24 (95%CI 2.12–8.50), P<0.001]. ⑤The major adverse events included neutropenia (84.54%), thrombocytopenia (41.24%), anemia (68.04%), and nausea/vomiting (65.98%), 14 patients (14.43%) had liver function abnormality, 1 patient had acute renal function injury during the treatment period. There was no chemotherapy-related death occurred. CONCLUSION: The DICE regimen is effective in refractory and relapsed NHL, and DICE is safe and well-tolerated. The high response rate of DICE regimen may correlate with good prognosis. For the B-NHL patients who used DICE combined with rituximab had longer OS than those patients who used DICE regimen only.