环孢菌素A联合经典化疗方案治疗难治性急性白血病临床观察

Clinical observation of CsA associated with classic chemoscheme to cure the refractory acute leukemia

目的:探讨环孢菌素A(CsA)作为耐药逆转剂联合化疗逆转难治性急性白血病(RAL)多药耐药(MDR)的临床疗效。方法:56例RAL患者随机分为逆转剂组30例(予CsA加经典化疗)和对照组26例(予经典化疗)。所有患者治疗前行耐药糖蛋白P-糖蛋白(P-gp)检测,比较两组MDR的逆转情况。结果:P-gp在RAL中高表达(62.5%)。逆转剂组治疗完全缓解(CR)率43.33%,总有效率66.67%;其中P-gp高表达者CR率52.63%,总有效率68.42%。对照组CR率19.23%,总有效率38.46%。逆转剂组总有效率明显高于对照组,差异有显著性(P<0.05)。结论:CsA能够逆转RAL的耐药性,CsA联合经典化疗方案治疗RAL特别是P-gp高表达者有良好的应用价值。

Objective To investigate the clinical effect of cyclosporin A （CsA） as a reversal agent associated with classical chemotheraphy to reverse multidrug resistance（MDR） in refractory acute leukemia（RAL）. Methods 56 cases of RAL were divided into reversal group（ CsA combined chemotherapy） and control group（ classic chemotherapy） at random. Before treatment drug resistance glucoprotein （P-gp） were detected in all patients. Reversal of multidrug resistance was compared between reversal group and control group. Results P-gp was overexpressed in RAL（62.5% ）. The rate of complete remission was 43.33% in reversal group and the overall effective rate was 66.67% ; The rate of complete remission was 52.63% and the total effective rate was 68.42% in the group overexpressed with P-gp. The rate of complete remission was 19.23% and the total effective rate was 38.46% in control group. The curative effect in revesal group was higher than that in control group and the difference was significant（P 〈 0. 05 ）. Conclusion CsA can reverse the drug resistance of RAL. CsA associated with classic chemoscheme is valuabe to cure RAL especially in the group with overexpression of P-gp.