CD33抗体为主方案治疗难治性白血病  

Efficacy and safety of gemtuzumab ozogamicin(mylotarg)-based regimens in patients with CD33-positive refractory leukemia

作　　者：吴穗晶[1] 杜欣[1] 林伟[1] 翁建宇[1] 张建军[1] 周茂华[1] 黄志新[1] 黄梓伦[1] 陆泽生[1] 陈运贤[2] 

机构地区：[1]广东省人民医院血液科,广东广州510100 [2]中山大学附属第一医院血液科,广东广州510080

出　　处：《现代肿瘤医学》2007年第11期1650-1653,共4页Journal of Modern Oncology

摘　　要：目的:评估CD33抗体为主方案治疗难治性白血病的疗效和不良反应。方法:采用CD33抗体为主方案对11例难治性白血病进行治疗。结果:CD33抗体为主方案治疗总有效率54%,其中完全缓解(CR)为36%,除血小板未完全缓解外均达到完全缓解标准(CRP)为18%,治疗后中位生存时间4.8月,缓解后中位生存时间8.2月。2例慢性粒细胞白血病急粒变均完全缓解,且BCR/ABL(-)。1例难治性急性淋巴白血病在缓解后即行异基因干细胞移植,至今无病生存已9月。不良反应有骨髓抑制(100%)、输注相关寒战发热(90%),肝静脉闭塞综合症(VOD)发生率55%,发生在干细胞移植后的患者和年龄大于60岁的患者。结论:本组资料显示CD33抗体为主方案对表达CD33的急慢性白血病有一定疗效。对于移植后复发和年龄大于60岁的患者,在使用CD33抗体时需注意患者肝脏情况,一旦出现VOD,及时处理。对于用药后缓解的患者,应尽早行异基因干细胞移植。To evaluate the efficacy and safety of gemtuzumab ozogamicin（mylotarg）-based regimen. Methods： Eleven patients with refractory leukemia were inrolled in the study , four cases treated with single agent and the other seven cases treated with mylotarg and cytotoxic agents. Results ： The overall response rate was 54% （6/ 11 ）, with 36% （4/11） patients obtaining complete remission （CR） and 18% （ 2/11 ） achieving CRp （ CR without platelet recovery）. The median overall survival time after treatment was 4.8 months, and the median overall survival time after CR was 8.2 months. Two patients with myeloid blast phase of CML achieved CR, and BCR/ABL（ - ）. One patient received Allo - PBSCT after CR with refractory acute lymphocytic leukemia is still alive at present （9 months） with disease free. The common adverse events included myelosuppression（ 100% ）, infusion- related chills and fever （55%）. Six patients （55%） who developed hepatic veno - occlusive disease （VOD） were either over 60 years old or received auto - PBSCT. Conclusion： In patients with CD33 - positive refractory leukemia, mylotargbased regimens had a comparable response rate and offered a more favorable toxicity profile, especially for the patients with myeloid blast phase of chronic myeloid leukemia. It was also effective for the patient with refractory acute lymphocytic leukemia. In the treatment,we should pay attention to the hepatic condition. Once VOD occurs, it must be treated in time. For the patients with poor - prognosis, Allo - PBSCT needs to be taken into accout as soon as CR.

关 键 词：CD33抗体 难治性白血病 慢性粒细胞白血病急粒变 急性髓性白血病 急性淋巴细胞白血病 肝静 脉闭塞综合症 

分 类 号：R737.7[医药卫生—肿瘤]