CAJ | 학술논문

目的评价大剂量柔红霉素(HD-DNR)为基础的化疗方案治疗急性白血病的用药安全性和初步疗效.方法回顾性分析我院2010年6月至2012年8月间应用HD-DNR(DNR用量为90mg/m2×3 d)治疗的25例急性白血病患者临床资料,其中初治者14例,巩固化疗者8例,难治复发患者3例.评价化疗相关药物不良反应(尤其心脏毒性)和疗效.结果绝大多数患者的药物不良反应轻微,未出现明显的心脏不良反应,3级及以上的不良反应仅见于感染(14例,56％)和腹泻(3例,12％).无因不良反应强烈而停用或减量的病例.不良反应比较多见的是感染(92％)、射血分数降低(52.6％)、腹泻(48％)、恶心(36％)、呕吐(36％)、口腔溃疡(36％)、心肌缺血(32％).中性粒细胞达到＞0.5×109/L及血小板＞20×109/L的中位时间均为21d(范围分别为9～31d和9～ 38 d).25例患者中9例化疗前即存在感染,14例化疗后新出现感染,感染部位主要为胃肠道和呼吸系统.胃肠道及肝肾毒性反应多轻微.10例患者出现治疗后心脏射血分数下降,仅l例达2级水平,且不伴有相应临床症状.14例初治急性白血病患者中13例获得血液学完全缓解.8例巩固化疗患者持续缓解,3例难治复发患者未缓解.结论应用HD-DNR为基础的化疗方案治疗急性白血病不良反应多轻微,无显著心脏不良反应,90mg/m2×3 d是较安全有效的治疗剂量,在有条件的医院可以使用.
목적 평개대제량유홍매소(HD-DNR)위기출적화료방안치료급성백혈병적용약안전성화초보료효.방법 회고성분석아원2010년6월지2012년8월간응용HD-DNR(DNR용량위90mg/m2×3 d)치료적25례급성백혈병환자림상자료,기중초치자14례,공고화료자8례,난치복발환자3례.평개화료상관약물불량반응(우기심장독성)화료효.결과 절대다수환자적약물불량반응경미,미출현명현적심장불량반응,3급급이상적불량반응부견우감염(14례,56％)화복사(3례,12％).무인불량반응강렬이정용혹감량적병례.불량반응비교다견적시감염(92％)、사혈분수강저(52.6％)、복사(48％)、악심(36％)、구토(36％)、구강궤양(36％)、심기결혈(32％).중성립세포체도＞0.5×109/L급혈소판＞20×109/L적중위시간균위21d(범위분별위9～31d화9～ 38 d).25례환자중9례화료전즉존재감염,14례화료후신출현감염,감염부위주요위위장도화호흡계통.위장도급간신독성반응다경미.10례환자출현치료후심장사혈분수하강,부l례체2급수평,차불반유상응림상증상.14례초치급성백혈병환자중13례획득혈액학완전완해.8례공고화료환자지속완해,3례난치복발환자미완해.결론 응용HD-DNR위기출적화료방안치료급성백혈병불량반응다경미,무현저심장불량반응,90mg/m2×3 d시교안전유효적치료제량,재유조건적의원가이사용.
Objective To evaluate the safety and therapeutic effect of high-dose daunorubicin-based (HD-DNR) chemotherapy in the treatment of acute leukemia (AL).Methods The clinical data of 25 AL patients,including 14 cases for induction chemotherapy,8 for consolidation chemotherapy and 3 for reinduction therapy,which were treated with HD-DNR (DNR dosage of 90 mg/m2× 3 d) between June 2010 and August 2012 in our hospital were retrospectively analyzed,the adverse reaction of chemotherapy,especially cardiac toxicity and therapeutic effect were evaluated.Results Most of the adverse reactions were mild,including cardiac toxicity,and no patient discontinued therapy because of HD-DNR related toxicities.Grade 3 or higher adverse reactions occurred only in the infection (56％) and diarrhea (12％).Withdrawal or dose reduction due to strong adverse reactions was not observed in all patients.Adverse reactions of infections (92％),lower ejection fraction (52.6％),diarrhea (48％),nausea (36％),vomiting (36％),dental ulcer (36％) and myocardial ischemia (32％) were relatively more common.The median time of neutrophil count reached to ≥0.5× 109/L and platelet ≥20× 109/L were both 21 days (ranged 9-31 and 9-38 days).Nine patients were complicated with infections before chemotherapy and 14 after chemotherapy,mainly occurred in gastrointestinal tract and respiratory system.Gastrointestinal,liver and kidney toxicity was slight.The cardiac ejection decreased in 10 cases,but only 1 reached grade 2 without clinical symptoms.Of the 14 AL patients for induction chemotherapy,13 achieved hematological complete remission.Eight patients received HD-DNR as consolidation chemotherapy remained complete remission,while 3 refractory/relapsed patients remained non-remission.Conclusion The adverse reaction of HD-DNR based chemotherapy for AL treatment was mild,no obvious cardiac adverse reaction occurred.The treatment dose of DNR at 90 mg/m2 ×3 d can be safely and effectively used to treat acute leukemia.