氟达拉滨治疗恶性淋巴瘤29例报告

Treatment of Lymphoma Patients with Fludarabine- Based Regimens:a Report of 29 Cases

背景与目的:氟达拉滨(fludarabine)是近年治疗慢性淋巴细胞白血病和低度恶性淋巴瘤的新药,国外报道Fludarabine治疗低度恶性非霍奇金淋巴瘤(NHL)有效率得到进一步提高。本研究的目的是观察含Fludarabine方案治疗我国NHL的疗效和不良反应。方法:从2001年4月到2003年12月期间,共收治经我院确诊的NHL29例,其中男性18例,女性11例;中位年龄53岁(27～79岁);其中低度恶性组22例,中度恶性组7例。治疗方法均采用含Fludarabine的方案,其中采用FMD(fludarabine,mitoxantrone和dexamethasone)治疗19例,采用Rituximab(美罗华)-FMD治疗3例,其余7例分别采用FD(fludarabine,dexamethasone)、FC(fludarabine,CTX)黄慧强,等.氟达拉滨治或单药Fludarabine等治疗。中位疗程数为3(1～6)个。结果:29例NHL中可评价疗效的有25例,其中可评价疗效的低度恶性组21例中,有效率为86%(18/21),完全缓解(CR)率为38%(8/21);中度恶性组中4例可评价疗效者均为复治患者,Fludarabine方案治疗无效。全组共化疗74个疗程,主要不良反应为骨髓抑制和轻度胃肠道反应,其中白细胞下降发生率为61%(Ⅲ+Ⅳ度8%),血小板下降发生率18%(Ⅲ+Ⅳ度4%),血红蛋白下降发生率26%,均为轻度,需G-CSF支持占5%疗程,均不需要输红细胞和血小板;轻度恶心、呕吐发生率为20%。

BACKGROUND & OBJECTIVE: Fludarabine is one of the most effect iv e agents for indolent lymphoma and chronic lymphocyte leukemia (CLL). Response r ate of single agent for chemotherapy- naive patients ranged from 40% to 87% with 14- 60% complete remission (CR) rate has been reported abroad while the response rate of 30% - 70% and the CR rate of 10% - 38% for pre- treat ed patients. Significantly higher response rate can be yielded by combined regim en such as FN, FMD, and FC, etc. The purpose of this study was to investigate th e efficacy and toxicity of fludarabine- based regimen for patients with lymphom a in China. METHODS: Twenty- nine patients with lymphoma were enrolled into thi s study from April 2001 to December 2003. There were 18 male and 11 female patie nts with median age of 53 years old (ranged from 27 to 79). Twenty- two patient s were low- grade lymphoma and 7 were intermediate- grade lymphoma.Nineteen pa tients had been treated by FMD(Fludarabine 25 mg/m2 d1- 3,Mitoxantrone 8 mg/m2 d1 and Dexamethasone 20 mg d1- 4) while 3 by R- FMD (Rituximab+ FMD) and 7 by other fludarabine- containing regimens. The median therapeutic cycles were 3 (1- 6). RESULTS: Twenty- five patients were available for objective evaluatio n in 29 enrolled patients. The response rate and the CR rate for indolent group were 86% (18/21) and 38% (8/21). No response was obtained in 4 cases of inte rmediate grade lymphoma. Myelosuppression and mild GI toxicity were major side e ffects. The rates of leucopenia, thrombocytopenia, and anemia were 61% (Ⅲ + Ⅳ , 8% ), 18% (Ⅲ + Ⅳ , 4% ), and 26% , respectively. G- CSF was necess ary only in 5% of cycles without red cell or platelet transfusion. Mild nausea and vomiting account for 20% . Five cases of febrile neutropenia during chemot herapy were controlled by intravenous antibiotics and supportive care. Transient liver function abnormality and jaundice encountered in 1 patient and diffusive skin rash in another one. CONCLUSION: Fludarabine- based regimen is highly effe ctive for indolent lymphoma with mild toxicity. Further investigation is warrant ed.