改良VDLP方案在老年急性淋巴细胞白血病中的应用研究  

Application of modified VDLP regimen for acute lymphoblastic leukemia in elderly patients

作　　者：王业生[1] 孙玲[2] 焦雪丽[3] 宋永平[1] 

机构地区：[1]河南省肿瘤医院血液科,郑州450000 [2]郑州大学第一附属医院血液科,450000 [3]郑州市第三人民医院血液科,450000

出　　处：《中华老年医学杂志》2016年第9期975-977,共3页Chinese Journal of Geriatrics

基　　金：国家自然科学基金项目（81173094）

摘　　要：目的观察改良VDLP（长春新碱＋柔红霉素＋门冬酰胺酶＋泼尼松）方案对老年急性淋巴细胞白血病（ALL）的治疗效果及不良反应。方法将2009年1月至2014年12月来我院就诊的初诊老年急性淋巴细胞白血病患者31例随机分成两组：实验组16例和对照组15例。对照组诱导化疗采取传统的VDLP方案诱导治疗（长春新碱2mg，第1、8、15天；柔红霉素30～40mg／m2，第1～3天，第15～16天；左旋门冬酰胺6000～10000U，第11、14、17、20天；泼尼松1mg／kg，第1～14天，继之减量，1～2周减停）；实验组诱导化疗采取改良VDLP方案诱导治疗（长春新碱2mg，第1、8、15天；柔红霉素30～40mg／m2，第1～3天；门冬酰胺酶6000～10000U，第11、14、17、20天；泼尼松1mg／kg，第1～14天，继之减量，1～2周减停）。观察两组患者的缓解率及并发症情况。结果实验组完全缓解率53．3％，对照组为58．3％，差异无统计学意义（P〉0．05）。实验组治疗相关病死率6．3％、重症感染发生率31．3％，对照组分别为46．3％、66．7％。实验组与对照组之间的治疗相关病死率、重症感染发生率的差异有统计学意义（P〈0．05）结论改良VDLP方案与传统VDLP方案相比，有更好的耐受性，更适合老年ALL患者的诱导化疗。Objective To investigate the efficacy of modified VDLP （vincristine ＋ daunorubicin ＋ L-asparaginase ＋ prednisone） for acute lymphoblastic leukemia （ALL） in elderly patients and its adverse reactions. Methods 31 elderly patients diagnosed as ALL at the initial visit from Jan. 2009 to Dec. 2014 were randomly divided into the experiment group （n = 16） and the control group （n=15）. Patients in the control group received traditional VDLP chemotherapy （vincristine 2 mg at 1, 8, 15 days; daunorubicin 30-40 mg/m2 at 1, 2, 15, 16 days; L-asparaginase 6 000-10 000 U at 11, 14, 17, 20 days; prednisone 1 mg/kg at 1 to 14 days）, whereafter underwent a gradual dose reduction and drug withdrawal within 1-2 weeks. Patients in the experiment group received the modified VDLP chemotherapy （vincristine 2rag at 1, 8, 15 days; daunorubicin 30-40 mg/m2 at 1 3 days; L asparaginase 6 000-10 000 U at 11, 14, 17, 20 days; prednisone 1 mg/kg at 1 to 14 days）, whereafter underwent a gradual dose reduction and drug withdrawal within 1-2 weeks. The complete response （CR） rate and complications were recorded. Results The CR rates were 53.3% in modified VDLP group and 58.3% in VDLP group, and there was no statistically significant difference between two groups （P 〈 0.05 ）. The treatment-related mortality and the incidence of severe infection had significant differences between the modified VDLP and VDLP groups （6.3% vs. 46.3%, 31.3% vs. 66.7%, both P〈0.05）. Conclusions Compared with VDLP, the modified VDLP is more tolerable and suitable for the elderly patients with ALL.

关 键 词：抗肿瘤联合化疗方案 白血病 淋巴样 

分 类 号：R733.71[医药卫生—肿瘤]