沙立度胺治疗急性白血病近期临床疗效观察

The short-term outcomes of patients with acute leukemia treated by thalidomide

目的 探讨沙立度胺 (反应停 )在治疗急性白血病 (AL)中的作用。方法 38例AL中 ,初治 2 7例 ,随机分为常规化疗加反应停治疗 (A)组和常规化疗 (B)组。复治 11例 ,列为C组 ,全部应用化疗加反应停。用Ⅷ因子相关抗原和CD3 4 单抗免疫组化染色的方法 ,观察患者治疗前后骨髓微血管密度 (MVD)。用ELISA的方法测定患者治疗前后血清血管内皮细胞生长因子 (VEGF)的浓度。反应停起始剂量 2 0 0mg/d ,每 1周增加 5 0mg/d ,直到 4 0 0～ 5 0 0mg/d ,应用 4～ 6个月。 结果 两组初治病例的完全缓解 (CR)率和有效率 :CR +部分缓解 (PR)及达CR所需疗程数用或不用反应停均无差异 ,其CR率和有效率分别为 5 7 1%和 5 3 8%及 78 6 %和 76 9%。复治组CR率 2 7 3% ,有效率 5 4 5 %。A、B两组CR患者随访 6个月 ,A组复发率较低。患者MVD、VEGF治疗前与正常对照组相比差异非常显著 (P <0 0 0 1)。治疗前VEGF水平与疗效呈负相关。用反应停组无特殊的不良反应。结论 反应停治疗可维持AL患者的持续缓解状态 ,减少复发。在AL的治疗中加用反应停是合理的新的治疗策略。

Objective To study the efficacy of thalidomide for treating acute leukemia(AL). Methods 38 cases of AL were studied. 27of the 38 cases receiving initial treatment were randomly divided into two groups, one treated with routine chemotherapy plus thalidomide (A) and the other with routine chemotherapy alone (B). 11 of the 38 were relapsing cases and all treated with routine chemotherapy plus thalidomide (C). Marrow microvascular density (MVD) and vascular endothelial growth factor (VEGF) were examined with factor-Ⅷ related antigen/CD_ 34 immunohistogical stain and ELISA respectively before and after the treatment. The initial dose of thalidomide was 200 mg/d and increased to 400-500 mg/d by increasing 50 mg/d weekly for 4 to 6 months. Results The complete remission (CR) rate and efficacy rate were 57.1%, 53.8% and 78.6%, 76.9% in the two groups respectively with no statistical difference. The CR rate and efficacy rate in the relapsing group were 27.3%, 54.5%. The relapsing rate 6 months after the treatment was low in the thalidomide group. MVD and VEGF were significantly different before and after the treatment ( P <0.001). There was a negtive correlation between the MVD, VEGF and efficacy. The relapsing rate was low in cases with low MVD, VEGF. No particular side effects were observed in thalidomide group. Conclusion Anti-angiogenesis may decrease relapse and maintain recovery state of AL patients. There are no severe side effects in the thalidomide group.