Cyclosporine, prednisone, and high-dose immunoglobulin treatment of angioimmunoblastic T-cell lymphoma refractory to prior CHOP or CHOP-like regimen.
Cyclosporine, prednisone, and high-dose immunoglobulin treatment of angioimmunoblastic T-cell lymphoma refractory to prior CHOP or CHOP-like regimen.
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DOI：
10.5732/cjc.011.10071
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发表时间：
2011-10-01
影响因子：
--
通讯作者：
Lin, Tong-Yu
中科院分区：
文献类型：
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作者：
Chen, Xing-Gui;Huang, He;Lin, Tong-Yu
血管免疫母细胞性T细胞淋巴瘤（AITL）是一种罕见的外周T细胞淋巴瘤的独特亚型，具有侵袭性过程和预后差，没有标准的治疗。12例至少两次初始CHOP或CHOP样方案失败的患者入组本研究，并接受个体化环孢素（CsA）、泼尼松（PDN）和每月大剂量静脉注射免疫球蛋白（HDIVIG）治疗。根据CsA血药谷浓度和肾功能个体化调整CsA剂量。对所有患者进行反应、毒性和存活率检查。最显著的毒副反应（≥ 2级）为感染（16.7%）、肾功能不全（8.3%）、高血压（8.3%）、糖尿病（8.3%）和失眠（16.7%）。1例患者（8.3%）因3级肾毒性和随后的4级肺部感染停止治疗。未观察到给药相关死亡。总有效率为75.0%（完全缓解33.3%，部分缓解41.7%）。中位随访时间为25.5个月，中位缓解持续时间为20个月（范围：12 - 49个月），中位无进展生存期（PFS）为25.5个月（范围：10 - 56个月）。2年PFS率为81.5%。我们的研究结果表明，CsA，PDN和HDIVIG的组合是一个有效的补救方案，难治性或复发性AITL与可预测和管理的毒性。
Angioimmunoblastic T-cell lymphoma (AITL) is a rare, distinct subtype of peripheral T-cell lymphoma, possessing an aggressive course and poor prognosis with no standard therapy. Twelve patients who have failed at least two initial CHOP or CHOP-like regimens were enrolled in this study and treated with individualized cyclosporine (CsA), prednisone (PDN), and monthly, high-dose intravenous immunoglobulin (HDIVIG). The dose of CsA was adjusted individually based on the blood trough concentration of CsA and renal function. All patients were examined for response, toxicity and survival. The most significant toxicities (≥ grade 2) were infection (16.7%), renal insufficiency (8.3%), hypertension (8.3%), diabetes (8.3%) and insomnia (16.7%). Discontinuation of treatment occurred in one patient (8.3%) due to grade 3 renal toxicity and subsequent grade 4 pulmonary infection. Treatment-related death was not observed. The overall response rate was 75.0% (complete response, 33.3%; partial response, 41.7%). With a median follow-up of 25.5 months, the median duration of response was 20 months (range, 12 to 49 months) and the median progression-free survival (PFS) was 25.5 months (range, 10 to 56 months). The 2-year PFS rate was 81.5%. Our findings indicate the combination of CsA, PDN and HDIVIG is an effective salvage regimen for refractory or relapsed AITL with predictable and manageable toxicity.