FLAG方案治疗复发及难治成人急性淋巴细胞白血病  

FLAG regimen in the treatment of refractory or relapsed adult acute lymphoblastic leukemia

作　　者：张涛[1] 张永清[1] 王一苇[1] 梁蓉[1] 白庆咸[1] 杨岚[1] 王文清[1] 顾宏涛[1] 高广勋[1] 舒汨汨[1] 陈协群[1] 

机构地区：[1]第四军医大学西京医院血液内科,陕西西安710032

出　　处：《现代肿瘤医学》2010年第11期2235-2238,共4页Journal of Modern Oncology

摘　　要：目的:观察FLAG方案化疗对复发或难治的成人淋巴细胞白血病的疗效和安全性。方法:对19例复发、难治的成人急性淋巴细胞白血病患者进行氟达拉滨、阿糖胞苷、粒细胞集落刺激因子联合的(FLAG)补救方案化疗。其中5例为原发耐药患者,14例为首次复发患者。结果:给予补救化疗后,8例患者(42.1%)达到完全缓解,10例患者(52.6%)未缓解,1例患者死于感染。完全缓解患者的中性粒细胞数在达到0.5×109/L和1×109/L以上的平均时间分别为开始治疗后的第18(范围为15到24天)和第21天(范围为19到26天),血小板数达到20×109/L和100×109/L以上的平均时间分别为开始化疗后的第22(范围为17到23天)和第31天(范围为26到36天)。19例患者中有18例(94.7%)出现了高于38.5℃的发热,其中10例为不明原因发热,8例为感染所致。主要的非血液学不良作用为粘膜炎(16/19或84.2%)和肝毒性的增加(8/19或42.1%),对于这些不良作用,患者一般都可耐受。达到缓解的8例患者接受了第二轮FLAG方案化疗,此后其中4例患者接受了异基因干细胞移植(3例来源于同胞相合供者,1例来源于无关供者),另外4例患者因缓解后出现早期复发而未行移植。19例患者的中位生存期为7个月(范围为1到36个月),8例缓解患者的无病生存期和总生存期分别为6(范围为5到36个月)和10个月(范围为9到36个月)。4位接受异基因干细胞移植患者的无病生存期为12个月(范围为7到36个月)。结论:研究中,复发难治的成人急性淋巴细胞白血病患者对于FLAG方案化疗是容易承受的,毒性可以耐受,该方案可使部分患者达到完全缓解,从而接受同种异基因移植治疗。Objective：To investigate the efficacy and safty of fludarabine,cytarabine and granulocyte colony-stimulating factor（FLAG） chemotherapy on relapsed or refractory adult acute lymphoblastic leukemia patients（ALL）.Metheds： Nineteen patients with relapsed/refractory adult ALL were treated with salvage therapy which is combined of fludarabine,cytarabine and granulocyte colony-stimulating factor.Five patients had primary refractory disease,and 14 were in first relapse.Results： Eight（42.1%） patients achieved complete remission（CR） following salvage therapy,whereas 10（52.6%） patients were inefficacy,and one patient died of infection.In patients achieving CR,the median time to reach absolute neutrophil count（ANC） more than 0.5×109/L and 1×109/L was 18（range 15-24） and 21（range 19-26） days from the start of chemotherapy,respectively.Platelet levels of more than 20×109/L and 100×109/L were achieved in a median time of 22（range 17-23） and 31（range 26-36） days,respectively.Eighteen of nineteen patients（94.7%） were observed fever more than 38.5°C,10 of whom had fever of unknown origin,and 8 of whom had documented infections.The main nonhematological side effects were mucositis（16/19,84.2%） and transient liver toxicity increase（8/19 or 42.1%）,but both were generally tolerated.All eight patients who achieved CR received a second course with FLAG,and four patients underwent allogeneic stem cell transplantation（three from sibling-donors,one from a irrelevent donor）,while four did not reach that stage due to early relapse from CR.The median overall survival（OS） for all 19 patients was 7（range 1-36） months;for the eight responders,the disease-free survival（DFS） and the OS were 6（range 5-36） and 10（9-36） months,respectively;the four patients who received allogeneic stem cell transplantation had a DFS of 12（range 7-36） months.Conclusions： FLAG is a well-tolerated regimen in the relapsed/refractory ALL patients;the toxicity is acceptable,which e

关 键 词：急性淋巴细胞白血病 复发 难治 FLAG方案 

分 类 号：R733.71[医药卫生—肿瘤]