CLINICAL OBSERVATION OF METRONOMIC CHEMOTHERAPY COMBINED WITH CLEARING HEAT AND DETOXICATING TRADITIONAL CHINESE MEDICINE IN THE TREATMENT OF REFRACTORY AND RELAPSED ELDERLY LYMPHOMA

Abstract

Objective: The elderly patients with malignant lymphoma had poor response to standard chemotherapy, high relapse rate after remission, short survival time and poor quality of life. Guidelines recommended salvage therapy for patients with relapsed and refractory lymphomas, while the elderly cannot tolerate high-dose chemotherapy and hematopoietic stem cell transplantation, a new protocol suitable for this population has been under discussion. Studies have shown that low-dose metronomic chemotherapy has a unique therapeutic effect in the treatment of mouse malignant tumors. Our previous clinical observations have shown that it can induce remission, improve the quality of life and prolong survival in some patients. Traditional Chinese Medicine believes that the elderly patients with lymphoma often have congenital deficiency of kidney essence, resulting in deficiency of vital qi, viscera, meridians, yin and yang, qi and blood disorder, To recover the feelings of six sexual feelings or warm heat evil, so that the evil influence into the viscera and bone marrow, resulting in the stagnation of Qi and blood stasis, phlegm and blood stasis are intertwined. According to the theory of "Wei Qi Ying Xue" from the "Fu Qi Qi Ying Xue" to treat and detoxify. Metronomic chemotherapy has good tolerance and prolongation of survival in the treatment of malignant tumor. Modern pharmacological studies have found that many Chinese herbs for clearing away heat and detoxification could inhibit the proliferation of lymphoma cells, inhibit angiogenesis and regulate immune function. Fully accord with the concept of metronomic chemotherapy, the combination of Qingrejiedu decoction and oral chemotherapy is a new combination of metronomic chemotherapy. In order to verify the efficacy of low-dose continuous oral chemotherapy combined with Qingrejiedu decoction, we made a preliminary attempt for the treatment of elderly lymphoma with refractory or recurrence. Methods: Sixty-three cases of refractory or relapsed non-Hodgkin's lymphoma were treated with metronomic chemotherapy combined with Qingrejiedu decoction and Qingrejiedu decoction, and were treated with Qingrejiedu decoction and metronomic chemotherapy. Aged 66 to 93 years, median age 74 years, male 37 cases, female 26 cases. According to the Chinese medicine diagnosis, 3 cases of deficiency of qi and blood were classified according to syndrome differentiation, There were 37 cases of deficiency of liver and kidney yin and 23 cases of deficiency of spleen and kidney. They were treated with traditional Chinese medicine based on dialectical treatment. Patients were treated with selective low-dose dexamethasone, thalidomide, Lenalidomide, methotrexate or etoposide according to their condition and economic condition. The median follow-up was 15 months and 46 patients survived with a total survival rate of 73%. Seventeen patients died, of which 15 were disease progression; One patient died of lung infection. Another died of sudden cardiac death. Metronomic chemotherapy combined with heat-clearing and detoxifying Chinese herbs showed mild side effects, such as mild leukopenia, mild asthenia, mild diarrhea or constipation, which were the main side effects of grade I. The quality of life has improved markedly. Conclusion: Heat-clearing and detoxifying Chinese herbs combined with metronomic chemotherapy is a simple and effective method for treatment, It is a well-tolerated and effective method to improve the quality of life, which is suitable for outpatient treatment and follow-up. It is helpful to improve the prognosis, improve the quality of life, prolong the survival and lighten the economic burden of the patients by treating the patients with refractory lymphoma in the elderly. Keywords: non-Hodgkin lymphoma (NHL); salvage treatment.