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: ① There 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. ② The 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), χ2= 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 ]. ⑤ The 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.
目的: 观察DICE方案（顺铂＋异环磷酰胺＋依托泊苷＋地塞米松）治疗复发／难治非霍奇金淋巴瘤（NHL）患者的疗效和安全性。
方法: 回顾性分析2008年9月1日至2013年12月31日在北京大学肿瘤医院接受DICE方案治疗的97例复发／难治NHL患者的临床资料。
结果: ①97例患者中男64例（65.08%），女33例（34.02%），中位年龄49(13~84）岁。T细胞淋巴瘤9例，B细胞淋巴瘤88例[其中弥漫大B细胞淋巴瘤（DLBCL）71例（73.20%）]。难治（原发耐药）60例（61.86%），一线治疗后复发37例。35例B细胞淋巴瘤患者联合应用利妥昔单抗。26例患者在挽救化疗结束后行自体造血干细胞移植（auto-HSCT）。②治疗后达到完全缓解（CR）、部分缓解（PR）患者分别为22、24例，总有效率（ORR）为47.42%（46/97）。复发组ORR高于难治组[67.57%（25/37）对35.00%（21/60），χ2=9.736，P= 0.002]。③全部97例患者中位随访时间为15.0 (1.5~80.0）个月，预期中位无进展生存（PFS）、总生存（OS）时间分别为12.0（95%CI 5.0~19.0）、26.0 (95%CI 6.0~45.9）个月。④auto-HSCT组（26例）与非auto-HSCT组（71例）中位OS时间差异无统计学意义[41.0 (95%CI 8.9~73.1）对22.0（95%CI 8.5~35.5）个月，P=0.361]。DICE方案获得CR/PR患者（46例）中位OS时间长于疾病稳定／进展患者（51例）（56.0个月对18.5个月，P<0.001）。利妥昔单抗组的中位OS时间长于非利妥昔单抗组（51.5个月对28.5个月，P=0.041）。多因素分析结果显示DICE方案近期疗效是OS的独立预后因素[HR=4.24 (95%CI 2.12~8.50），P<0.001]。⑤82例（84.54%）患者出现粒细胞减少，43例（41.24%）患者出现血小板减少，66例（68.04%）出现贫血，14例（14.43%）出现肝功能损伤，1例出现急性肾功能损伤，64例（65.98%）出现不同程度的消化道反应。无治疗相关死亡。
结论: DICE方案治疗复发／难治NHL患者有效，安全性良好；DICE方案治疗有效（CR/PR）的患者预期生存较好；DICE联合利妥昔单抗可延长B细胞淋巴瘤患者OS时间。