Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma
Outcome with the hyper-CVAD regimens in lymphoblastic lymphoma
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DOI：
10.1182/blood-2003-12-4428
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发表时间：
2004-09-15
期刊：
影响因子：
20.3
通讯作者：
Kantarjian, H
中科院分区：
文献类型：
--
作者：
Thomas, DA;O'Brien, S;Kantarjian, H
淋巴母细胞淋巴瘤 (LL) 的治疗随着急性淋巴细胞白血病 (ALL) 化疗方案的使用而不断发展。我们使用强化化疗方案 hyper-CVAD（分次环磷酰胺、长春新碱、阿霉素和地塞米松）或在我们机构用于治疗 ALL 的改良 hyper-CVAD 治疗了 33 名 LL 患者。诱导巩固治疗是在 5 至 6 个月内进行 8 或 9 个交替化疗周期，并进行鞘内化疗预防，然后进行维持治疗。对就诊时患有纵隔疾病的患者进行了巩固放射治疗。未进行自体或同种异体干细胞移植的巩固治疗。诊断时，80% 为 T 细胞免疫表型，70% 为 III 至 IV 期，70% 患有纵隔受累，9% 患有中枢神经系统 (CNS) 疾病。在患者中，30 名（91%）获得完全缓解，3 名（9%）获得部分缓解。平均 13 个月内，10 名患者 (30%) 复发或进展。 33 名患者的 3 年无进展生存率和总生存率估计分别为 66% 和 70%。已知 T 细胞免疫表型的患者的估计值分别为 62% 和 67%。除就诊时的 CNS 疾病外，没有任何参数（例如年龄、分期、血清乳酸脱氢酶 [LDH]、β(2) 微球蛋白）似乎影响结果。对超 CVAD 方案进行修改并加强蒽环类药物并没有改善结果。该程序的其他修改可能包括掺入单克隆抗体和/或核苷类似物，特别是对于反应缓慢的人或患有残留纵隔疾病的人。 (C) 2004 年，美国血液学会。
Therapy of lymphoblastic lymphoma (LL) has evolved with use of chemotherapy regimens modeled after those for acute lymphocytic leukemia (ALL). We treated 33 patients with LL with the intensive chemotherapy regimens hyper-CVAD (fractionated cyclophosphamide, vincristine, Adriamycin, and dexamethasone) or modified hyper-CVAD used for ALL at our institution. Induction consolidation was administered with 8 or 9 alternating cycles of chemotherapy over 5 to 6 months with intrathecal chemotherapy prophylaxis, followed by maintenance therapy. Consolidative radiation therapy was given to patients with mediastinal disease at presentation. No consolidation with autologous or allogeneic stem cell transplantation was performed. At diagnosis, 80% were T-cell immunophenotype, 70% were stages III to IV, 70% had mediastinal involvement, and 9% had central nervous system (CNS) disease. Of the patients, 30 (91%) achieved complete remission, and 3 (9%) achieved partial response. Within a median of 13 months, 10 patients (30%) relapsed or progressed. Estimates for 3-year progression-free and overall survival for the 33 patients were 66% and 70%, respectively. Estimates for the patients with known T-cell immunophenotype were 62% and 67%, respectively. No parameters (eg, age, stage, serum lactate dehydrogenase [LDH], beta(2) microglobulin) appeared to influence outcome except for CNS disease at presentation. Modification of the hyper-CVAD regimen with anthracycline intensification did not improve outcome. Other modifications of the program could include incorporation of monoclonal antibodies and/or nucleoside analogs, particularly for slow responders or those with residual mediastinal disease. (C) 2004 by The American Society of Hematology.