重组人红细胞生成素大剂量冲击维持疗法治疗30例肿瘤相关贫血的临床报告

High-dose Induction Therapy Followed by Maintenance with Recombinant Human Erythropoietin for 30 Patients with Tumor-related Anemia

背景与目的:贫血是癌症患者常见的并发症,重组人红细胞生成素(recombinanthumanerythropoietin,rhEPO)的应用能改善癌症贫血患者的症状,但其最佳使用方法仍在探讨之中。为探索rhEPO在肿瘤相关贫血患者中的最佳用药方案,本研究在同期接受化疗的癌症贫血患者中进行了rhEPO冲击维持疗法的临床应用研究。方法:采用开放性非随机的临床研究方法,选取2004年5月至2005年2月30例同期接受化疗且伴随贫血的恶性肿瘤患者,第1周采用rhEPO120000U冲击用药(40000U皮下d1,3,5),然后rhEPO每周40000U皮下维持用药,共3周(d8,15,22);比较治疗前及治疗开始后每2周的血红蛋白(Hb)水平和红细胞压积(Hct)值。结果:入组患者给予rhEPO后Hb水平呈持续上升趋势,在治疗后第2周及第4周Hb比基础值(79.56g/L)上升≥20g/L的患者分别占27.59%和61.90%;第2周(n=29)及第4周(n=21)Hb的平均值分别为90.26g/L和96.81g/L,与治疗前相比差异均具有显著性(P<0.05);第2周及第4周Hct的平均值分别为27.01%和30.17%,与治疗前(24.29%)相比也有所提高(P=0.062,P=0.001)。所有患者均耐受良好。结论:在恶性肿瘤贫血患者中使用rhEPO大剂量冲击维持疗法,可有效快速提高患者的血红蛋白水平,改善患者的贫血状况,该疗法耐受性较好,值得进一步扩大临床研究。

BACKGROUND ＆ OBJECTIVE： Anemia is a common complication of cancer patients. Recombinant human erythropoietin （rhEPO） can alleviate the symptoms of cancer-related anemia. However, the optimal use of rhEPO is still on investigation. This study was to find out the optimal use of rhEPO in anemic cancer patients undergoing chemotherapy. METHODS,From May, 2004 to Feb, 2005, 30 patients with cancer-related anemia receiving concurrent chemotherapy were enrolled. This open-labeled, non-randomized, and pilot study evaluated the response rate of induction rhEPO 120 000 U （40 000 U was subcutaneously injected on dl,3,5） followed by subcutaneous injection of maintenance dose of 40 000 U once a week for 3 weeks （d8, 15, 22）. Hemoglobin （Hb） and hematocrit （Hct） were measured before treatment and fortnightly during the treatment. RESULTS. Mean Hb maintained increasing during treatment. In week 2 （n= 29） and week 4 （n=21）, there were 27.59% and 61.90% patients, respectively, whose Hb value had increased more than 20 g/L from the baseline （79.56 g/L） and mean Hb were 90.26 g/L and 96.81 g/L respectively （P〈0.05）. And mean Hct at week 2 and week 4 were 27.01% and 30.17% respectively, which were higher than the baseline （24.29%） （P= 0.062 and 0.001 respectively）. All patients demonstrated fine tolerance. CONCLUSION：Induction therapy followed by maintenance with rhEPO can improve the level of hemoglobin significantly and quickly in anemic cancer patients.