CAJ | 학술논문

目的观察FLAG方案在成年人复发难治性急性淋巴细胞白血病(ALL)诱导化疗中的疗效及安全性.方法对2008年1月至2012年1月收治的复发难治性ALL患者(治疗组)20例,采用FLAG方案补救化疗；选择20例2002年1月至2008年1月住院的复发难治性ALL患者作为对照组,采用首次诱导方案和去甲氧柔红霉素(IDA)联合依托泊苷及大剂量甲基氢化泼尼松方案,比较两组的疗效及不良反应,应用流式细胞术(FCM)以白血病细胞特异分化抗原为标志监测两组微小残留病(MRD),并与传统骨髓形态学结果进行比较.结果治疗组和对照组血液学不良反应相似(P=0.548),治疗组其他非血液系统不良反应包括肝损伤(4/20)、心脏毒性(1/20),较对照组(9/20和4/20)轻；大多数不良反应均可耐受.治疗组CR 8例(40.0％),CR患者平均无病生存期和总生存期分别为6个月(4～30个月)和11个月(9～30个月)；对照组CR 7例(35.0％),CR患者平均无病生存期和总生存期分别为4个月(3 ～ 30个月)和9个月(9～ 30个月),两组总生存期差异无统计学意义.治疗组早期复发率[5.0％(1/20)]和髓外复发率(0)较对照组[20.0％[4/20)和10.0％(2/20)]低.结论FLAG方案治疗成年人复发难治性ALL不良反应可耐受,为患者选择同种异基因移植争取了时间.
목적 관찰FLAG방안재성년인복발난치성급성림파세포백혈병(ALL)유도화료중적료효급안전성.방법 대2008년1월지2012년1월수치적복발난치성ALL환자(치료조)20례,채용FLAG방안보구화료；선택20례2002년1월지2008년1월주원적복발난치성ALL환자작위대조조,채용수차유도방안화거갑양유홍매소(IDA)연합의탁박감급대제량갑기경화발니송방안,비교량조적료효급불량반응,응용류식세포술(FCM)이백혈병세포특이분화항원위표지감측량조미소잔류병(MRD),병여전통골수형태학결과진행비교.결과 치료조화대조조혈액학불량반응상사(P=0.548),치료조기타비혈액계통불량반응포괄간손상(4/20)、심장독성(1/20),교대조조(9/20화4/20)경；대다수불량반응균가내수.치료조CR 8례(40.0％),CR환자평균무병생존기화총생존기분별위6개월(4～30개월)화11개월(9～30개월)；대조조CR 7례(35.0％),CR환자평균무병생존기화총생존기분별위4개월(3 ～ 30개월)화9개월(9～ 30개월),량조총생존기차이무통계학의의.치료조조기복발솔[5.0％(1/20)]화수외복발솔(0)교대조조[20.0％[4/20)화10.0％(2/20)]저.결론FLAG방안치료성년인복발난치성ALL불량반응가내수,위환자선택동충이기인이식쟁취료시간.
Objective To investigate the efficacy and safety of fludarabine cytarabine and granulocyte colony stimulating factor (FLAG) chemotherapy on adult relapsed or refractory adult acute lymphoblastic leukemia (ALL) patients.Methods Twenty adult patients with relapsed or refractory ALL were treated with salvage therapy which was combined of fludarabine,cytarabine and granulocyte colony stimulating factor (FLAG).Another 20 cases in control group were treated with primal induction regimen and idamycin combined with etoposide and high-dose methylprednisolone.Sides effects of 2 groups were compared and FCM was used to investigate the cells with leukemia associated with immunophenotype,final comparing with bone marrow morphology.Results Hematologic toxicity was similar both in the treatment group and control group.Nonhematology complications consisted of heart and liver toxicity (1/20 and 9/20) were weaker than those in control group (4/20 and 1/20),which were mild to moderate and could be alleviated with supportive therapy.The median overall survival was no significant difference between both sides,eights patients (40.0 ％) who achieved complete remission received salvage therapy,the disease-free survival and the median overall survival were 6 months (range 4-30 months) and 11 months (range 9-30 months),respectively.Seven patients (35.0 ％) achieved complete remission in the treatment group,the disease-free survival and the median overall survival were 4 months (range 3-30 months) and 9 months (range 9-30 months) for 7 patients,respectively.In the treatment group early recurrence [5.0 ％ (1/20)] and outside marrow of recurrence rate (0)were lower than in control group [20.0 ％ (4/20) and 10.0 ％ (2/20)].Conclusion FLAG is a well-tolerated regimen for adult relapsed or refractory ALL patients which enables patients to receive allogeneic stem cell transplantation.