FLAG方案治疗成年人复发难治性急性淋巴细胞白血病的疗效观察  

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

作　　者：刘宇宏[1] 张艳[1] 葛繁梅[1] 封青海[1] 高雪梅[1] 张筱东[1] 

机构地区：[1]延安大学附属医院血液免疫科,716000

出　　处：《肿瘤研究与临床》2013年第1期41-43,46,共4页Cancer Research and Clinic

摘　　要：目的 观察FLAG方案在成年人复发难治性急性淋巴细胞白血病（ALL）诱导化疗中的疗效及安全性。方法 对2008年1月至2012年1月收治的复发难治性ALL患者（治疗组）20例，采用FLAG方案补救化疗；选择20例2002年1月至2008年1月住院的复发难治性ALL患者作为对照组，采用首次诱导方案和去甲氧柔红霉素（IDA）联合依托泊苷及大剂量甲基氢化泼尼松方案，比较两组的疗效及不良反应，应用流式细胞术（FCM）以白血病细胞特异分化抗原为标志监测两组微小残留病（MRD），并与传统骨髓形态学结果进行比较。结果 治疗组和对照组血液学不良反应相似（P＝0.548），治疗组其他非血液系统不良反应包括肝损伤（4／20）、心脏毒性（1／20），较对照组（9／20 和4／20）轻；大多数不良反应均可耐受。治疗组CR 8例（40.0 %），CR患者平均无病生存期和总生存期分别为6个月（4～30个月）和11个月（9～30个月）；对照组CR 7例（35.0 %），CR患者平均无病生存期和总生存期分别为4个月（3～30个月）和9个月（9～30个月），两组总生存期差异无统计学意义。治疗组早期复发率[5.0 %（1／20）]和髓外复发率（0）较对照组[20.0 %（4／20）和10.0 %（2／20）]低。结论 FLAG方案治疗成年人复发难治性ALL不良反应可耐受，为患者选择同种异基因移植争取了时间。Objective To investigate the efficacy and safety of fludarabine cytarabine and granulocyte colony stimulating factor （FLAG） chemotherapy on adult relapsed or refractory adult acute lymphoblastic leukemia （ALL） patients. Methods Twenty adult patients with relapsed or refractory ALL were treated with salvage therapy which was combined of fludarabine,cytarabine and granulocyte colony stimulating factor （FLAG）. Another 20 cases in control group were treated with primal induction regimen and idamycin combined with etoposide and high-dose methylprednisolone. Sides effects of 2 groups were compared and FCM was used to investigate the cells with leukemia associated with immunophenotype, final comparing with bone marrow morphology. Results Hematologic toxicity was similar both in the treatment group and control group.Nonhematology complications consisted of heart and liver toxicity （1/20 and 9/20） were weaker than those in control group（4/20 and 1/20）, which were mild to moderate and could be alleviated with supportive therapy. The median overall survival was no significant difference between both sides, eights patients （40.0 %） who achieved complete remission received salvage therapy, the disease-free survival and the median overall survival were 6 months （range 4-30 months） and 11 months （range 9-30 months）, respectively. Seven patients （35.0 %） achieved complete remission in the treatment group, the disease-free survival and the median overall survival were 4 months （range 3-30 months） and 9 months （range 9-30 months） for 7 patients, respectively. In the treatment group early recurrence [5.0 % （1/20）] and outside marrow of recurrence rate （0） were lower than in control group [20.0 % （4/20） and 10.0 % （2/20）]. Conclusion FLAG is a well-tolerated regimen for adult relapsed or refractory ALL patients which enables patients to receive allogeneic stem cell transplantation.

关 键 词：白血病 淋巴细胞 急性 复发 难治 药物疗法 联合 

分 类 号：R733.71[医药卫生—肿瘤]