ประสิทธิภาพการรักษาผู้ป่วย Non-Hodgkin Lymphoma ที่กลับซ้ำหรือดื้อต่อการรักษาด้วยยาเคมีบำบัด ESHAP ที่ไม่ได้รับการรักษาต่อด้วยการปลูกถ่ายเซลล์ต้นกำเนิดเม็ดเลือด ในโรงพยาบาลมหาราชนครเชียงใหม่
Keywords:
ESHAP, Relapsed lymphoma, Refractory lymphoma, Salvage chemotherapyAbstract
Abstract: The standard of care for patients with relapsed or refractory non-Hodking lymphoma (NHL) is the treatment with salvage chemotherapy followed by autologous stem cell transplantation (ASCT). ESHAP is one of the salvage chemotherapy, proven to have the efficacy for treatment of relapsed NHL. We therefore evaluated the efficacy and safety of ESHAP, not followed by ASCT due to co-morbidity and medical coverage. Materials and Methods: We retrospectively studied the treatment outcome and efficacy of ESHAP chemotherapy as a second-line treatment for 69 patients with relapsed and refractory NHL who had been treated at Maharaj Nakorn Chiang Mai Hospital from January 1999 to January 2010. Results: Fifty-five patients (79%) had diffuse large B-cell lymphoma while minority of patients had T-cell NHL (n = 8). Majority of the patients (72%) had early relapsed or refractory disease. Half of the patients were in stage IV with elevated serum LDH. The overall response (OR) rate was 53.6% with complete response rate of 18%. Patients with relapsed disease had a better response rate than those with refractory disease (65% v 30%, p = .007). At a median time of follow up of 328 days, 1-year event free (EFS) and overall survival (OS) were 34.4% and 52.7%, respectively. From multivariate analyses, the refractory or early relapsed disease was independently associated with a poorer EFS and OS. The neutropenia grade 3-4 was found in 11.9% of ESHAP treatment cycles (n = 320 cycles). However, with the G-CSF prophylaxis, febrile neutropenia occurred in only 4.0% of treatment cycles. Conclusion: These data confirm the efficacy and tolerability of ESHAP as a second-line chemotherapy in relapsed NHL, especially in late relapsed disease. Nevertheless, the remission was not durable and majority of the patients had disease progression within a year after treatment. For that reason, the combination of targeted therapy with ESHAP followed by ASCT is mandatory to improve the treatment outcomes in these patients.
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