格列卫联合HA方案治疗20例Ph染色体阳性急性白血病  

Glivec in Combination with HA Regimen for Treatment of 20 Patients with Ph Chromosome Positive Acute Leukemia

作　　者：孟凡义[1] 郑维扬[1] 刘晓力[1] 宋兰林[1] 徐兵[1] 张钰[1] 黄芬[1] 

机构地区：[1]第一军医大学南方医院血液科,广东广州510515

出　　处：《癌症》2003年第8期840-843,共4页Chinese Journal of Cancer

基　　金：广东省社会发展攻关课题(No.B30202)

摘　　要：背景与目的:格列卫是2001年5月美国FDA批准用于临床挽救性治疗慢性粒细胞白血病(chronicmyelocyticleukemia,CML)的基因靶向药物,单药治疗由CML转变来的Ph染色体阳性急性白血病的疗效较低。体外实验显示,格列卫与多种化疗药物具有协同作用,但有关其临床联合应用的报道极少。本研究目的在于探讨应用格列卫联合HA方案治疗Ph染色体阳性急性白血病(Ph+-AL)的疗效及其不良反应。方法:20例(男性16例,女性4例,中位年龄43岁)Ph+-AL患者的外周血或骨髓中原始细胞均>30%,Ph染色体或荧光原位杂交(FISH)双标双融合bcr/abl异位探针检查的阳性率均≥90%,其中由CML转变的Ph+急性非淋巴细胞白血病(Ph+-ANLL)17例、Ph+-ALL1例,原发性Ph+-ALL2例。表现复杂核型15例,t(9;22)5例。确诊至本治疗前的中位时间为4个月,其中18例曾用多种化疗方案2～4疗程治疗无效。本次治疗,20例均口服格列卫0.3～0.6g/d,疗程中位数2.5(1～6.5)月;Ph+-ANLL患者联合HA(HHT1～2mg/d,持续静脉滴注6～24h,Ara-C30～50mg/d,10～14天/月);Ph+-ALL患者联合HAOP或DVP方案(HA剂量同前;DNR40mg/d,1～3天,持续静脉滴注;VCR每周2mg,静脉推注,强的松60～80mg/d,1～14天),疗程中位数2个。发生骨髓抑制者减量或停用格列卫,同时加用G-CSF;格列卫的骨髓细胞学和遗?BACKGROUND &OBJECTIVE: Glivec was approved by Food &Drug Administration (FDA) in May 2001 as a gene target drug for treatment of chronic myeloid leukemia (CML) and showed a good curative effect for patients with chronic myeloid leukemia in chronic phase. But its effectiveness was poor in patients with CML blast phase treated with Glivec alone. Glivec was reported having synergetic effect with other chemical agents in vitro, but there is few report in clinical combined application. In this paper, we analyzed effectiveness of Glivec in combination with homoharringtonine (HHT) and cytarabine (Ara C) for patients with Ph chromosome positive acute leukemia (Ph+ AL), and investigated patientstolerance to side effects of this trial. METHODS: A total of 20 patients (16 males and 4 females, median age was 43 years) were eligible. Blasts in peripheral blood (PB) or bone marrow (BM) were both more than 30%, bcr/abl fusion genes were detected positive in 90%cells by analysis of karyotype or fluorescence in situ hybridization (FISH). Five patients showed t(9;22) and other 15 patients showed more complicated chromosome abnormality. Of these 20 patients, 17 patients developed Ph+ ANLL from CML, 1 case developed Ph+ ALL, and other 2 cases were primary Ph+ ALL. The median interval from diagnosis to Glivec treatment was 4 months. Eighteen of 20 patients received different chemotherapy regimens for 2-4 treatment cycles, but no one reached hematological complete remission (HCR). All patients were given oral Glivec daily at the doses of 0.3-0.6 g in a median treatment time of 2.5 months (range, 1-6.5 months). Ph+ ANLL patients were infused with HHT over 6-24 hours daily at the doses of 1-2 mg intravenously and Ara C 30-50 mg daily subcutaneously for 10-14 days; 3 patients with Ph+ ALL received HOAP or DOP combination treatment regimens (One cycle consists of HA with the same dosage described above for Ph+ ANLL patients for 7 days, daunorubicin at the dose of 40 mg/d intravenously for 3 days, vincristine at the dose of 2 m

关 键 词：格列卫 HA方案 治疗 PH染色体 阳性 急性白血病 

分 类 号：R733.71[医药卫生—肿瘤]