High-risk fludarabine-pretreated B-cell chronic lymphocytic leukemia's high response rate following sequential DHAP and alemtuzumab administration though in absence of molecular remission
High-risk fludarabine-pretreated B-cell chronic lymphocytic leukemia's high response rate following sequential DHAP and alemtuzumab administration though in absence of molecular remission
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高风险氟达拉滨预处理的 B 细胞慢性淋巴细胞白血病在连续 DHAP 和阿仑单抗给药后的高缓解率，尽管没有分子缓解
DOI：
10.1385/mo:23:3:359
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发表时间：
2006
期刊：
影响因子：
3.4
通讯作者：
C. Tarella
中科院分区：
文献类型：
--
作者：
I. Majolino;M. Ladetto;A. Locasciulli;D. Drandi;F. Benedetti;A. Gallamini;T. Chisesi;A. Blasio;M. Boccadoro;C. Tarella
B-CLL患者在出现时伴有耐药/复发疾病或不良预后因素，适合接受替代治疗。在目前的试点研究中，我们研究了一种新的强化化疗免疫治疗方法，用于高危的氟达拉滨预处理患者。纳入了10例耐药/复发的晚期B-CLL患者。年龄37-60岁（中位53岁）。除一人外，所有人都有未突变的IgVH状态。治疗方案包括用两个dhp疗程减容，然后用阿仑妥珠单抗（30mg， 8次剂量），然后用中/高剂量环磷酰胺动员外周血祖细胞（PBPC），在高剂量米托蒽酮+L-Pam后进行自体移植。dhap -阿仑单抗联合治疗非常有效。10名患者中有8名对dhp有反应，有一次完全缓解。阿仑单抗。总体反应增加到9个，完全缓解增加到5个。阿仑单抗PB双阳性克隆CD5+/CD19+淋巴细胞下降，中位纯化率99.95%。由于PBPC动员不良，只有5例患者进行了自体移植，其中3例出现了移植后复发。6例进入完全缓解期的患者在研究开始后3 - 23个月无疾病，其中3例在3、7和22个月时仍处于缓解期。然而，分子评估定期显示，在所有PBPC采集和治疗后随访样本中，均存在微小残留疾病。DHAP/阿仑单抗的使用似乎有助于复发/难治性疾病的再诱导缓解。高危B-CLL患者。然而，自体移植物的加入通常不可行，临床应用也有问题。因此，应考虑维持缓解的其他策略。
B-CLL patients with resistant/relapsed disease or adverse prognostic factors at presentation are suitable for alternative treatments. In the present pilot study we investigated a novel intensive chemo-immunotherapy approach for high-risk, fludarabine pretreated patients. Ten patients with resistant/relapsed, advanced stage B-CLL were included. Age was 37–60 yr (median 53). All but one had an unmutated IgVH status. The treatment schedule included debulking with two DHAP courses followed by alemtuzumab (30 mg, eight doses), followed by peripheral blood progenitor cell (PBPC) mobilization with intermediate/high-dose cyclophosphamide and by autografting after high-dose mitoxantrone+L-Pam. The DHAP-alemtuzumab combination was highly effective. Eight patients out of 10 responded to DHAP, with a single complete remission. Following alemtuzumab. the number of overall responses increased to nine, and the complete remissions to five. After alemtuzumab PB double-positive clonal CD5+/CD19+ lymphocytes dropped, with median purification rate 99.95%. Owing to poor PBPC mobilization, only five patients underwent autografting, and three of these experienced post-graft recurrence. The six patients entering complete remission were free of disease 3–23 mo after study entry, and three of them were still in remission at 3,7, and 22 mo. However, molecular evaluation regularly revealed persistence of minimal residual disease, both in all PBPC collections tested and in post-treatment follow-up samples. The use of DHAP/alemtuzumab appears useful to re-induce disease remission in relapsed/refractory. high-risk B-CLL patients. However, the addition of autograft was not usually feasible and of questionable clinical use. Other strategies should thus be considered for remission maintenance.
用于实时 PCR 定量急性淋巴细胞白血病残留疾病的免疫球蛋白重链共有探针。
影响因子：
20.3
作者：
Donovan,JW;Ladetto,M;Zou,G;Neuberg,D;Poor,C;Bowers,D;Gribben,JG
通讯作者：
Gribben,JG