两种不同类型门冬酰胺酶在成人急性淋巴细胞白血病治疗中的疗效观察
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摘要
目的比较应用不同门冬酰胺酶的VDLP方案在急性淋巴细胞白血病(ALL)患者中的近期、远期疗效及安全性。方法前瞻性收集湖北医药学院附属襄阳医院血液科2010年1月至2012年1月确诊为ALL的成人患者95例。根据治疗方案的不同采用随机数字表法分为A组[培门冬酶(PEG-Asp)的VDLP方案]52例和B组[左旋门冬酰胺酶(L-Asp)的VDLP方案]43例。比较两组的基线资料、初始病情、近期及远期疗效、治疗不良反应。结果两组的基线资料、初发病情、近期、远期疗效组间均差异无统计学意义(P> 0. 05); A组过敏反应5例,B组为11例,A组过敏反应发生率显著低于B组(P <0. 05),其余不良反应发生率两组均差异无统计学意义(P> 0. 05)。结论 PEG-Asp及L-Asp两种不同VDLP方案在ALL患者中近期、远期疗效相当,但PEG-Asp过敏反应率更低,有较高的临床应用价值。
Objective To compare the short-term,long-term curative effects and security of VDLP regimens with different asparaginase in adult patients with acute lymphoblastic leukemia(ALL). Methods The clinical information of adult patients diagnosed with ALL received treatment at our hospital from Jan 2010 to Jan 2012 was prospectively analyzed. Patients included were randomly divided into two groups according to the therapeutic regimen,group A(VDLP regimen with PEG-Asp) and group B(VDLP regimen with L-Asp).The baseline data,the initial condition,the short-term,long-term curative effects and adverse effects in these two groups were compared.Results 95 patients were enrolled in this research,including 52 patients in group A and 43 in group B. The baseline data,the initial condition,the short-termand long-term curative effects in two groups were with no significant difference(P > 0. 05). Patients in group A were with a significant lower incidence of allergic response than group B(5 vs. 11,P < 0. 05). Other adverse effects in these two groups were also with no significant difference(P > 0. 05). Conclusion Compared with VDLP regimen with L-Asp,VDLP regimen with PEGAsp had a close efficacy,a lower incidence of allergic response and a greater clinical value.
Objective To compare the short-term,long-term curative effects and security of VDLP regimens with different asparaginase in adult patients with acute lymphoblastic leukemia(ALL). Methods The clinical information of adult patients diagnosed with ALL received treatment at our hospital from Jan 2010 to Jan 2012 was prospectively analyzed. Patients included were randomly divided into two groups according to the therapeutic regimen,group A(VDLP regimen with PEG-Asp) and group B(VDLP regimen with L-Asp).The baseline data,the initial condition,the short-term,long-term curative effects and adverse effects in these two groups were compared.Results 95 patients were enrolled in this research,including 52 patients in group A and 43 in group B. The baseline data,the initial condition,the short-termand long-term curative effects in two groups were with no significant difference(P > 0. 05). Patients in group A were with a significant lower incidence of allergic response than group B(5 vs. 11,P < 0. 05). Other adverse effects in these two groups were also with no significant difference(P > 0. 05). Conclusion Compared with VDLP regimen with L-Asp,VDLP regimen with PEGAsp had a close efficacy,a lower incidence of allergic response and a greater clinical value.
引文
[1] COUTURIER MA,HUGUET F,CHEVALLIER P,et al. Cerebral venous thrombosis in adult patients with acute lymphoblastic leukemia or lymphoblastic lymphoma during induction chemotherapy with l-asparaginase:The GRAALL experience[J]. Am J Hematol,2015,90(11):986-991.
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[4]中华医学会血液学分会,中国抗癌协会血液肿瘤专业委员会.中国成人急性淋巴细胞白血病诊断与治疗专家共识[J].中华血液学杂志,2012,33(9):789-792.
[5] ZUURBIER SM,LAUW MN,COUTINHO JM,et al. Clinical course of cerebral venous thrombosis in adult acute lymphoblastic leukemia[J]. J Stroke Cerebrovasc Dis,2015,24(7):1679-1684.
[6] HIJIYA N,VAN DER SLUIS IM. Asparaginase-associated toxicity in children with acute lymphoblastic leukemia[J]. Leuk Lymphoma,2016,57(4):748-757.
[7] KAKO S,AKAHOSHI Y,HARADA N,et al. Meta-analysis and meta-regression analysis to compare the outcomes of chemotherapy for T-and B-lineage acute lymphoblastic leukemia(ALL):the use of dexamethasone,L-asparaginase,and/or methotrexate may improve the outcome of T-lineage ALL[J]. Ann Hematol,2016,95(1):87-92.
[8] MESRIAN TH,MOJTABAVI NM,RAHGOZAR S,et al. Integrative computational in-depth analysis of dysregulated miRNA-mRNA interactions in drug-resistant pediatric acute lymphoblastic leukemia cells:an attempt to obtain new potential gene-miRNA pathways involved in response to treatment[J]. Tumour Biol,2016,37(6):7861-7872.
[9] MERLEN C,BONNEFOY A,WAGNER E,et al. L-Asparaginase lowers plasma antithrombin and mannan-binding-lectin levels:Impact on thrombotic and infectious events in children with acute lymphoblastic leukemia[J]. Pediatr Blood Cancer,2015,62(8):1381-1387.
[10] NELKEN B,CAVE H,LEVERGER G,et al. A phase i study of clofarabine with multiagent chemotherapy in childhood high risk relapse of acute lymphoblastic leukemia(VANDEVOL study of the french SFCE acute leukemia committee)[J]. Pediatr Blood Cancer,2016,63(2):270-275.
[11] PARMENTIER JH,MAGGI M,TARASCO E,et al. Glutaminase activity determines cytotoxicity of L-asparaginases on most leukemia cell lines[J]. Leuk Res,2015,39(7):757-762.
[2] SUGIMOTO K,SUZUKI HI,FUJIMURA T,et al. A clinically attainable dose of L-asparaginase targets glutamine addiction in lymphoid cell lines[J]. Cancer Sci,2015,106(11):1534-1543.
[3] MEANY HJ,SEIBEL NL,KRAILO M,et al. Feasibility study of a novel experimental induction protocol combining B43-PAP(AntiCD19)immunotoxin with standard induction chemotherapy in children and adolescents with relapsed b-Lineage ALL:a report from the children's oncology group[J]. J Immunother,2015,38(7):299-305.
[4]中华医学会血液学分会,中国抗癌协会血液肿瘤专业委员会.中国成人急性淋巴细胞白血病诊断与治疗专家共识[J].中华血液学杂志,2012,33(9):789-792.
[5] ZUURBIER SM,LAUW MN,COUTINHO JM,et al. Clinical course of cerebral venous thrombosis in adult acute lymphoblastic leukemia[J]. J Stroke Cerebrovasc Dis,2015,24(7):1679-1684.
[6] HIJIYA N,VAN DER SLUIS IM. Asparaginase-associated toxicity in children with acute lymphoblastic leukemia[J]. Leuk Lymphoma,2016,57(4):748-757.
[7] KAKO S,AKAHOSHI Y,HARADA N,et al. Meta-analysis and meta-regression analysis to compare the outcomes of chemotherapy for T-and B-lineage acute lymphoblastic leukemia(ALL):the use of dexamethasone,L-asparaginase,and/or methotrexate may improve the outcome of T-lineage ALL[J]. Ann Hematol,2016,95(1):87-92.
[8] MESRIAN TH,MOJTABAVI NM,RAHGOZAR S,et al. Integrative computational in-depth analysis of dysregulated miRNA-mRNA interactions in drug-resistant pediatric acute lymphoblastic leukemia cells:an attempt to obtain new potential gene-miRNA pathways involved in response to treatment[J]. Tumour Biol,2016,37(6):7861-7872.
[9] MERLEN C,BONNEFOY A,WAGNER E,et al. L-Asparaginase lowers plasma antithrombin and mannan-binding-lectin levels:Impact on thrombotic and infectious events in children with acute lymphoblastic leukemia[J]. Pediatr Blood Cancer,2015,62(8):1381-1387.
[10] NELKEN B,CAVE H,LEVERGER G,et al. A phase i study of clofarabine with multiagent chemotherapy in childhood high risk relapse of acute lymphoblastic leukemia(VANDEVOL study of the french SFCE acute leukemia committee)[J]. Pediatr Blood Cancer,2016,63(2):270-275.
[11] PARMENTIER JH,MAGGI M,TARASCO E,et al. Glutaminase activity determines cytotoxicity of L-asparaginases on most leukemia cell lines[J]. Leuk Res,2015,39(7):757-762.