含克拉屈滨方案治疗复发难治急性淋巴细胞白血病11例疗效  

Efficacy of cladribine⁃based regimens in treatment of 11 patients with refractory/relapsed acute lymphoblastic leukemia

作　　者：王买红 刘学 秦先念 陈果 谭栩 马影影 张诚 张曦 Wang Maihong;Liu Xue;Qin Xiannian;Chen Guo;Tan Xu;Ma Yingying;Zhang Cheng;Zhang Xi(Medical Center of Hematology,Xinqiao Hospital of Army Medical University,Chongqing 400037,China)

机构地区：[1]陆军军医大学第二附属医院新桥医院血液病医学中心,重庆400037

出　　处：《白血病．淋巴瘤》2023年第9期528-532,共5页Journal of Leukemia & Lymphoma

基　　金：重庆市科卫联合医疗科研项目(2020MSXM102)。

摘　　要：目的探讨含克拉屈滨方案为基础治疗复发难治急性淋巴细胞白血病(ALL)的疗效及安全性。方法回顾性分析2018年1月至2022年7月收治的采用以CLAG(克拉屈滨+阿糖胞苷+重组人粒细胞集落刺激因子)方案治疗1个疗程的11例复发难治ALL患者的临床资料,总结疗效及安全性。结果11例患者中,男性7例,女性4例,中位年龄28岁(4~58岁);B⁃ALL 8例,急性混合细胞白血病1例,急性早期前体T淋巴细胞白血病2例;TP53突变1例,NOTCH1突变2例,KRAS突变2例,NRAS突变2例;1例染色体为超二倍体,1例为复杂染色体。11例患者中,CLAG+多柔比星脂质体治疗4例,CLAG+伊达比星+依托泊苷治疗1例,CLAG+依托泊苷治疗1例,CLAG+培门冬酶注射液+依托泊苷治疗1例,CLAG+甲氨蝶呤+依托泊苷治疗1例,CLAG+多柔比星脂质体+达雷妥尤单抗治疗1例,CLAG+伊达比星治疗1例,CLAG+西达本胺治疗1例。11例患者中,5例完全缓解,1例部分缓解,5例未缓解。主要不良反应为重度骨髓抑制(11例)、粒细胞缺乏伴发热(6例)、败血症(3例),无治疗相关死亡。结论含克拉屈滨方案为基础治疗复发难治ALL有效,安全性较好,患者可耐受。Objective To investigate the efficacy and safety of cladribine⁃based regimen for treatment of refractory/relapsed acute lymphoblastic leukemia(ALL).Methods The clinical data of 11 patients with refractory/relapsed ALL treated with 1 course of CLAG(cladribine+cytarabine+granulocyte colony⁃stimulating factor)regimen from January 2018 to July 2022 were retrospectively analyzed.The efficacy and safety were summarized.Results Among the 11 patients with refractory/relapsed ALL,there were 7 males and 4 females with a median age of 28 years(4-58 years).There were 8 cases of B⁃ALL,1 case of acute mixed cell leukemia,and 2 cases of acute early precursor T⁃lymphocytic leukemia;1 patient had TP53 mutation,2 patients had NOTCH1 mutation,2 patients had KRAS mutation,and 2 patients had NRAS mutation;1 case had hyperdiploid chromosome and 1 patient had complex chromosome karyotype.Among the 11 patients,4 cases received CLAG+liposomal doxorubicin,1 case received CLAG+idarubicin(IDA)+etoposide regimen,1 case received CLAG+etoposide regimen,and 1 case received CLAG+pegaspargase injection+etoposide regimen,1 case received CLAG+methotrexate+etoposide regimen,1 case received CLAG+liposomal doxorubicin+daratumumab regimen,1 case received CLAG+IDA regimen,and 1 case received CLAG+chidamide.Among the 11 patients,5 cases achieved complete remission,1 case achieved partial remission and 5 achieved non⁃remission.The main adverse effects were severe myelosuppression(11 cases),agranulocytosis accompanied with fever(6 cases),septicemia(3 cases),and no treatment⁃related death occurred.Conclusions cladribine⁃based regimen is effective in treating refractory/relapsed ALL.It has favorable safety and tolerance for patients.

关 键 词：白血病 淋巴样 克拉屈滨 复发 难治 治疗结果 

分 类 号：R733.71[医药卫生—肿瘤]