Combined VM‐26 and cytosine arabinoside in treatment of refractory childhood lymphocytic leukemia
Combined VM‐26 and cytosine arabinoside in treatment of refractory childhood lymphocytic leukemia
复制标题
VM-26联合阿糖胞苷治疗难治性儿童淋巴细胞白血病
作者：
G. Rivera;R. Aur;G. Dahl;C. Pratt;A. Wood;T. Avery
在该机构先前研究结果的基础上，VM-26和阿糖胞苷（ara-C）联合治疗33例难治性急性淋巴细胞白血病（ALL）儿童。化疗通过静脉给予，每周两次，持续四周，剂量为300 mg/m2的ara-C和50、75、110、165或200 mg/m2的VM-26。诱导了10例骨髓缓解（9例完全缓解，1例部分缓解），观察到的最显著副作用为低血压（2/33）和骨髓发育不良（20/33）。除75 mg/m2外，每种剂量的VM-26均获得治疗反应;所有剂量均出现骨髓抑制，200 mg/m2时延长最长。23例无应答者中有10例未完成计划的疗程。这一信息的重要性在于，VM-26和ara-C的组合对白血病晚期或从未达到初始缓解的患者有效。所有患者既往均接受过泼尼松、长春新碱、柔红霉素和L-天冬酰胺酶治疗。此外，10名应答者中有7名先前在其他药物组合中接受过ara-C。对于一线药物治疗失败风险高的新诊断患者，可能需要联合使用VM-26和ara-C。
On the basis of previous findings at this institution, VM‐26 and Cytosine Arabinoside (ara‐C) were used in combination to treat 33 children with refractory acute lymphocytic leukemia (ALL). Chemotherapy was given by vein twice a week for four weeks at dosages of 300 mg/m2 for ara‐C and 50, 75, 110, 165, or 200 mg/m2 for VM‐26. Ten marrow remissions (nine complete and one partial) were induced, with hypotension (2/33) and bone marrow hypoplasia (20/33) the most significant side effects observed. Therapeutic responses were obtained with each dosage of VM‐26 except 75 mg/m2; myelosuppression developed at all dosages, being most prolonged at 200 mg/m2. Ten of the 23 non‐responders did not complete their planned courses of therapy. The significance of this information is that combinations of VM‐26 and ara‐C were effective in patients who were either in late stages of their leukemia or had never achieved an initial remission. All had been previously treated with prednisone, vincristine, daunomycin and L‐asparaginase. In addition, seven of the 10 responders had previously received ara‐C in other drug combinations. The use of VM‐26 and ara‐C in combination may be warranted for newly diagnosed patients who are at high risk for treatment failure with first‐line drugs.