以氟达拉滨为主的联合化疗方案治疗初治慢性淋巴细胞白血病临床分析

The analysis of efficacy of fludarabine-based regimens in treatment of previously untreated chronic lymphocytic leukemia

目的：评价以氟达拉滨为主的联合化疗方案治疗初治慢性淋巴细胞白血病（CLL）的疗效，并观察其不良反应。方法：患者为初治CLL。患者的治疗采用单药氟达拉滨（F）或氟达拉滨加环磷酰胺（FC）方案。结果：CLL患者27例，中位年龄57（41～66）岁，男19例，女8例。14例完全缓解（CR），CR率为51．85％；总有效率（OR）为85．19％。单用F11例，CR率36．36％；FC方案16例，CR率62．5％，2组CR率比较差异无统计学意义（P〉0．05）。0和Ⅰ期患者17例，CR率为70．59％；Ⅱ～Ⅳ期患者10例，CR率为20％；2者比较差异有统计学意义（P〈0．05）。23例有效患者随访PFS，中位随访时间为14个月（2～32个月）。中位疾病无进展生存时间（PFS）未达到。结论：以F为基础的方案可以作为CLL的一线治疗方案。FC可能应作为CLL一线治疗的首选方案，特别是对Rai分期0或Ⅰ期患者。

Objective：To evaluate the efficacy of fludarabine-based regimens in treatment of previously untreated chronic lymphocytic leukemia（CLL）. Method： The patients with untreated chronic lymphocytic leukemia en rolled in our study. They received either fludarabine （F： 30 mg/m^2 for 5 days intravenously, repeated every 28 days）or FC combination therapy（fludarabine 30 mg/m^2 plus cyclophosphamide 250 mg/m^2 for 3 days intravenously, repeated every 28 days）. Both regimens were administered for 2 to 6 courses. Result：27 patients（M/F 19/8, median age 57 years, range 41-66）entered into our study. 14 of 27（51.85%）patients achieved complete remission （CR）, the overall response was 85.19%. 4 of 11（36.36%） patients after receiving fludarabine alone and 10 of 16（62.5 %）patients after receiving FC regimen achieved CR. There was no significant difference in CR rate between two regimens. The CR rate of the patients with Rai stage 0 or Ⅰ （12/17,70.59%）was significantly higher than those of the patients with Rai stage Ⅱ to Ⅳ （2/10,20 % ）（P〈0.05）. At a median follow-up of 14 months, the median duration of progression-free survival （PFS）has not reached. Conclusion： The fludarabine-based regimens can be the first-line treatment in patients with previously untreated CLL. FC regimen maybe the better choice, especially for patients with Rai stage 0 or Ⅰ.