改良FLAG方案治疗33例难治复发性急性白血病的初步分析  

Effect of Modified FLAG Regimen Therapy on 33 Patients with Relapsed /Refractory Leukemia

作　　者：孟凡义[1] 杨龙江[1] 徐兵[1] 刘晓力[1] 郑维扬[1] 张钰[1] 黄芬[1] 孙竞[1] 刘启发[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12期1330-1333,共4页Chinese Journal of Cancer

基　　金：广东省科技厅;卫生厅联合攻关重大专项(No.B30202)

摘　　要：背景与目的:FLAG方案用于治疗难治复发性急性非淋巴细胞性白血病(acutenon-lymphocyticleukemia,ANLL)已有多年,大多报道的CR率为50%～64%。本研究探讨改良FLAG方案(减少合并应用Ara-C剂量并在化疗前不用G-CSF)能否达到同样疗效,并减轻不良反应。方法:33例成人急性白血病中难治性ANLL16例,难治性急性淋巴细胞白血病(ALL)12例,复发性ALL5例。全部病例接受氟达拉宾30mg·(m2·d)-1,静滴,第1～5天;其中合并Ara-C200mg·d-1有18例,Ara-C500mg·d-1有5例,Ara-C1000mg·d-1有10例,全部静脉滴注5～7天为1疗程。应用Ara-C200mg·d-1组和ALL组化疗前不用G-CSF,ALL患者每周加用长春新碱2mg,共2次;强的松60～80mg·d-1,共14天。化疗后WBC<1.0×109/L者加用G-CSF,剂量均为300μg·d-1,皮下注射至WBC3.0×109/L以上。每疗程完成后复查骨髓。结果:16例难治性ANLL的CR率为56.3%,而12例难治性ALL的CR率为8.3%(P<0.01);难治性ANLL患者中Ara-C200mg·d-1组的CR率高于500～1000mg·d-1组(70%∶33%),但无统计学差异(P>0.05)。化疗后WBC0.6×109/L和血小板15.6×109/L的平均持续时间分别为5天和4.3天,Ara-C200mg·d-1组感染发生率明显低于500～1000mg·d-1Ara-C组(58.0%∶85.7%)(P<0.05)。结论:与经典的FLAG方案相比。BACKGROUND &OBJECTIVE: The hematological complete remission (CR ) rate of the FLAG regimen [fludarabine and cytarabine (Ara-C) and granulocyte-c olony stimulating factor] for relapsed and refractory acute non-lymphocytic leu kemia (ANLL) was 50-64%. The aim of this study was to investigate the modified FLAG regimen (Ara-C reduced to 200 mg per day intravenous injection for 5 to 7 days, and the patients were not administrated G-CSF before fludarabine and Ara -C) to examine whether it can achieve the same effectiveness and minor side eff ects. METHODS:Of 33 patients with acute leukemia, there were 16 cases with ANLL , 12 cases with refractory acute lymphocytic leukemia (ALL) and 5 cases with rel apsed ALL, respectively. All patients received fludarabine (Flu) 30 mg/m2/d intr avenous injection for 5 days. And every patient received simultaneously Flu in c ombination with Ara-C intravenously for 5-7 days, 18 cases with Ara-C at a do se of 200 mg per day, 5 cases with Ara-c 500 mg/d and 10 cases with Ara-c 1000 mg/d, respectively. One course consisted of 7 days. ALL patients and the patien ts received Ara-C at a dose of 200 mg per day were not treated with G-CSF befo re chemotherapy. ALL patients received vincristine at a dose of 2 mg/w for 2 tim es and prednisone 60-80 mg/d for 14 days. Of these 33 patients, the cases with white blood cell(WBC) counts less than 1.0×109/L were treated with G-CSF at a dose of 300 μg/d subcutaneously until WBC counts were more than 3.0×109/L. All patient were examined for bone marrow after every course. RESULTS: The CR rate of 16 patients with refractory ANLL was 56.3%, whereas the CR rate of 12 cases with refractory ALL was 17%(P< 0.01). The CR rate of the patients with refracto ry ANLL who received Ara-C 200 mg/d was higher than those with refractory ANLL receiving Ara-C at the medial doses (70%versus 33%, P >0.05). The average dur ations of WBC< 0.6×109/L and platele t< 15.6×109/L were 5 days and 4.3 days, r espectively. Infection rate of the patients receiving Ara-C 2

关 键 词：改良FLAG方案 治疗 难治复发性急性白血病 氟达拉宾 阿糖胞苷 

分 类 号：R733.71[医药卫生—肿瘤]