摘要
目的:研究基于培门冬酶(pegasparaginase,PEG-Asp)的多种化疗方案治疗儿童和成人初治及复发急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)和T细胞非霍奇金淋巴瘤(T cell Non-Hodgkin's lymphoma,T-NHL)的临床疗效及不良反应,为临床优化治疗提供新的治疗策略。方法:选取儿童和成人初治及复发ALL和T-NHL共62例,其中应用培门冬酶联合化疗22例(PEG-Asp联合化疗组),应用含左旋门冬酰胺酶的常规化疗方案40例(L-Asp常规化疗组),评价两种疗法的临床疗效、不良反应、住院时间、医疗费用,比较治疗相关死亡率并随访生存情况。结果:近期疗效分析显示,PEG-Asp联合化疗组总缓解20例(90.91%),CR 17例(77.27%),PR 3例(13.64%),L-Asp常规化疗组总缓解35例(87.5%),CR 29例(72.5%),PR 6例(15%),组间及亚组间比较均无显著性差异(P>0.05)。生存分析显示,6个月、12个月总生存率组间比较均无显著性差异(P>0.05)。观察期内门冬酰胺酶相关不良反应均为WHO毒性反应1-2级,无3-4级毒性反应和治疗相关死亡率。PEG-Asp联合化疗组过敏反应和高血糖发生率显著低于L-Asp常规化疗组,其它不良反应发生率组间比较均无显著性差异(P>0.05)。PEG-Asp联合化疗组均完成预期PEG-Asp治疗剂量,L-Asp常规化疗组仅29例(72.5%)完成L-Asp治疗剂量。PEG-Asp联合化疗组平均住院日10.5 d,较L-Asp常规化疗组住院18.9 d显著缩短,治疗总费用相对较低。结论:基于培门冬酶的化疗治疗急性淋巴细胞白血病和恶性淋巴瘤的临床疗效比较好,安全性较高,过敏反应发生率低,使得治疗剂量完整完成,保证了临床疗效。住院时间显著缩短,治疗总费用相对较低,替代L-Asp具有较好的临床应用前景;优化联合化疗方案用于更多病例以及远期生存率尚需进一步深入研究。
Objective:To explore the effectiveness and safety of combined chemotherapy with pegasparaginase(PEG-Asp) for treatment of patients with acute lymphoblastic leukemia(ALL) and T cell non-Hodgkin's lymphoma(TNHL) patients.Methods:A total of 62 ALL or T-NHL patients were diagnosed and treated in our department and were enrolled in this study.Among them,22 patients received the combined chemotherapy with PEG-Asp,while the other 40 patients received the standard chemotherapy with L- asparaginase(L-Asp) as the control.Therapeutic effectiveness,adverse effects,duration and expense of hospitalization,treatment- related mortality and survival were evaluated and compared in 2 different groups.Results:In group of combined chemotherapy with PEG-Asp,the overall response rate was 90.91%(20 cases),among them CR rate and PR rate are 77.27%(17 cases) and 13.64%(3 cases).respectively.In the group of standard chemotherapy with L-Asp,the overall response rate was 87.5%(35 cases),among them CR rate and PR rate were 72.5%(29 cases) and 15%(6 cases),respectively.The difference neither between PEG-Asp and L-Asp chemotherapy groups nor between ALL and T-NHL subgroups was significant(P >0.05).The 6- month and 12- month overall survival rates were not significantly different between the PEG-Asp and L-Asp chemotherapy groups,respectively(P >0.05).The adverse effects were identified as degree 1-2 according to the WHO criteria of drug toxicity.Neither the adverse effects identified as degree 3-4 nor the treatment- related death were observed.Expect for allergy and hyperglycaemia,the difference of side-effect incidence between the two groups were not significant(P > 0.05).The treatment for all the patients in PEG-Asp chemotherapy group was completed,while the treatment with L-Asp was completed only in 29 cases.Moreover,both average duration and expense of hospitalization after the combined chemotherapy were less than the control.Conclusion:With higher response rate,lower drug toxicity and allergy incidence,the combined chemotherapy with PEG-Asp can replace the standard chemotherapy with L-Asp in the treatment of ALL and T-NHL.The optimization of the combined chemotheropeutic protocols for more cases and long-term survival rates need to further and deeply explorate.
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2016年第2期405-410,共6页
Journal of Experimental Hematology
基金
2013年陕西省科学技术研究发展计划项目(2013K12-06-03)
