强化化疗方案治疗成年人B淋巴母细胞白血病/淋巴瘤（非特指型）的疗效分析  

Intensive Chemotherapy in Treatment of Adult B-Lymphoblastic Leukemia/Lymphoma （Not Otherwise Specified）

作　　者：赵冰冰[1] 熊红[1] 赵夏[2] 吴丽莉[3] 赵维莅[2] 王黎[2] 

机构地区：[1]上海市徐汇区中心医院血液科,200031 [2]上海交通大学医学院附属瑞金医院血液科,200025 [3]上海交通大学医学院附属瑞金医院病理科,200025

出　　处：《国际输血及血液学杂志》2014年第4期293-298,共6页International Journal of Blood Transfusion and Hematology

基　　金：国家自然科学基金资助项目（81101793,8125003）

摘　　要：目的 探讨环磷酰胺（CTX）＋长春新碱（VCR）＋阿霉素（ADM）＋地塞米松（Dex）强化化疗方案（hyper CVAD）治疗非特指型成年人B淋巴母细胞白血病/淋巴瘤（B-LBL/ ALL）的疗效、不良反应及影响患者生存及预后的相关因素.方法 收集2008年1月至2013年11月于上海交通大学医学院附属瑞金医院血液科治疗的51例初治为B-LBL/ALL患者为研究对象.按照骨髓内B淋巴母细胞所占比例,将其分为A组（n=6,骨髓内B淋巴母细胞＜25％,采取hyper CVAD化疗方案治疗）;B组[n=45,骨髓内B淋巴母细胞≥25％,采取VCR＋ Dex＋ CTX＋泼尼松（Pred） （VDCP）/VCR＋ Dex＋ CTX＋左旋门冬酰胺酶L-（ASP）＋Pred（VDCLP）联合hyper CVAD化疗方案治疗].对51例患者再按照巩固治疗方案是否应用门冬酰胺酶（ASP）,进一步分为应用ASP亚组（n=27）与未用ASP亚组（n=24）.对ASP过敏、肝功能异常或不愿意使用ASP者,则纳入未用ASP亚组,否则,则纳入应用ASP亚组.对两组及两亚组患者的疗效及总生存（OS）率进行相关统计学分析.本研究遵循的程序符合上海交通大学医学院附属瑞金医院人体试验委员会制定的伦理学标准,得到该委员会批准.两组及两亚组患者年龄、性别、美国东部肿瘤协作组（ECOG）制定的体能状态评分、起病时合并B症状、白细胞（WBC）计数＞30×109/L率及乳酸脱氢酶（LDH）升高率等分别比较,差异均无统计学意义（P＞0.05）.结果 A组6例患者经hyper CVAD方案化疗后,完全缓解（CR）率为83.3％（5/6）;对B组45例患者应用VDCP/VDCLP联合hyper CVAD方案化疗后,CR率为95.6％（43/45）.随访至终点时,本组51例患者的中位生存时间为40个月,1年和3年OS率分别为80.7％和63.5％.对影响预后的相关因素的分析结果显示,WBC计数＞30×109 /L[OR=7.117,95 ％CI（1.543～32.837）;P=0.012],ECOG评分为3～4分[OR=20.638,95％CI（4.108～103.668）;P=0.000 1],治疗未获CR[OObjective To analyze the clinical efficacy and safety of the intensive chemotherapy regimen hyper CVAD[cyclophosphamide （CTX） ＋ vincristine （VCR） ＋ adriamycin （ADM） ＋ dexamethasone （Dex）] in treatment of patients with B-lymphoblastic leukemia/lymphoma（B-LBL/ALL）,not otherwise specified,as well as the prognostic factors of these patients.Methods A total of fifty-one B-LBL/ALL patients who treatment into Shanghai Ruijing Hospital,Shanghai Jiao Tong University School of Medicine were enrolled from January 2008 to November 2013.According to rates of the bone marrow infiltration of B-lymphoblastic lymphocytes,patients were divided into two groups：A group （n =6,bone marrow infiltration 〈25%,treated with hyper CVAD regimen） and B group [n=45,bone marrow infiltration≥ 25 %,treated with VDCP [VCR ＋ Dex ＋ CTX ＋ prednisone （Pred）] regimen or VDCLP [VCR ＋-Dex ＋ CTX＋Pred＋ L-asparaginase（L-ASP）] regimen combined with hyper CVAD regimen].Concerning the consolidation treatment,the 51 patients were further divided into two sub-groups：with asparaginase（ASP）treatment sub-group （n=27） and without ASP treatment sub-group （n =24）.The SPSS 11.0 software was used to analyze the differences of efficacies between these two groups and two sub-groups,respectively.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Shanghai Ruijin hospital,Shanghai Jiao Tong University School of Medicine.If the patients who were allergy to ASP,or had liver dysfunction,as well as unwilling to receive ASP treatment were enrolled into without ASP treatment sub-group.There were no significant differences of patients＆#39; general clinical features between two groups and sub-groups,respectively （P 〉 0.05）.Results Among 6 patients with bone marrow infiltration〈25 % and treated with the hyper CVAD regimen,5 of them achieved complete remission （CR）,with CR rate as 83.3% （5/6）.Among 45 patients with bone marrow infiltration≥25%,treated

关 键 词：淋巴瘤 B细胞 白血病 B细胞 淋巴母细胞 抗肿瘤联合化疗方案 门冬酰胺酶 成年人 

分 类 号：R733[医药卫生—肿瘤]