hyper-CVTD/MA方案治疗恶性血液病疗效分析

Curative Effect of Hyper-CVTD/MA Regimen for Hematologic Malignancies

目的探讨hyper-CVTD/MA方案治疗中高危以上淋巴瘤及复发、难治急性淋巴细胞白血病的疗效和不良反应。方法中高危以上非霍奇金淋巴瘤25例,复发难治急性淋巴细胞白血病18例采用hyper-CVTD/MA方案化疗:环磷酰胺300mg/m2,每12小时1次,第1～3天,持续2h静滴;长春新碱1.4mg/(m2.d),第4,11天,持续24h静滴;吡柔比星50mg/(m2.d),第4天,静注;地塞米松20～40mg/(m2.d),第1～4天和第11～14天,静滴;MA方案:甲氨碟呤1.0g/(m2.d),第1天,持续24h静滴;阿糖胞苷1.0g/m2,每12小时1次,第2～3天,持续4h静滴。结果恶性淋巴瘤组完全缓解12例,部分缓解6例,稳定2例,死亡5例;急性淋巴细胞白血病组完全缓解9例,部分缓解3例,未缓解2例,死亡4例。副作用中胃肠道反应31例(72.09%)、感染32例(74.42%)、黏膜炎33(76.74%)、肝脏功能损害24(55.81%)、心脏毒性9(20.93%)。结论 hyper-CVTD/MA是治疗恶性淋巴系血液病的有效方案,积极预防及处理并发症。

Objective To investigate the clinical curative effect and adverse reaction of hyper-CVTD/MA regimen for intermediate-high and high risk lymphoma and relapsing or refractory acute lymphoblastic leukemia（ALL）.Methods Clinical records of 43 hematologic malignancies received hyper-CVTD/MA regimen include 25 cases of intermediate-high and high risk lymphoma and 18 cases of relapsing or refractory ALL.The hyper-CVTD regimen was：cyclophosphamide 300 mg·m^-2·q12h intravenously guttae continuing 2 h on d1 to d3,vincristine 1.4 mg/（m^2·d）intravenously guttae continuing 24 h on d4 and d11,pirarubicin 50 mg/（m^2·d）intravenous push on d4,dexamethasone 20 to 40 mg/（m^2·d）intravenously guttae on d1 to d4 and d11 to d14;MA regimen was：methotrexate 1.0 g/（m^2·d）intravenously guttae continuing 24 h on d1 and cytarabine 1.0 g·m^-2·q12h intravenously guttae continuing 4h on d2 to d3.Results In malignant lymphoma group,12 patients achieved complete remission,6 patients achieved partial remission,and 2 patients achieved stable and 5 patients died.In ALL group,9 patients achieved complete remission,3 patients partial remission,2 patients not remission and 4 patients died.31（72.09%）patients accompanied gastrointestinal tract reaction,32（74.42%）infection,33（76.74%）mucositis,24（55.81%）liver functional lesion,9（20.93%）cardiotoxic.Conclusion The hyper-CVTD/MA regimen is effective for malignant lymphoma and relapsing or refractory ALL,and the correlated complications should be controlled and prevented.