Low-risk gestational trophoblastic neoplasia outcome after treatment with VMP regimen from 2005 to 2017
Low-risk gestational trophoblastic neoplasia outcome after treatment with VMP regimen from 2005 to 2017
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2005年至2017年VMP方案治疗低危妊娠滋养细胞肿瘤结果
DOI：
10.1016/j.tjog.2019.03.008
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发表时间：
2019
影响因子：
2.1
通讯作者：
Zhou Ying
中科院分区：
文献类型：
--
作者：
Zhu Chenchen;Liu Hanyuan;Wei Ying;Shen Zhen;Qian Lili;Song Weiguo;Wang Juan;Wu Dabao;Zhang Xuefen;Zhou Ying
目的评价VMP方案治疗低危妊娠滋养细胞肿瘤（LR-GTN）的疗效及不良反应。材料与方法2005年至2017年，87例低危妊娠滋养细胞肿瘤患者接受VMP方案治疗，包括长春新碱（VCR）、甲氨蝶呤（MTX）和铂类药物其中68例患者接受VMP方案作为一线化疗，19例患者接受MTX失败的VMP方案作为二线化疗。分期和评分系统基于国际妇产科联合会（FIGO 2000）标准。结果VMP一线治疗方案缓解率为83.8%，治疗前β-hCG达7503.5IU/L时易产生耐药，以FAV和EMA-CO为挽救方案可达到完全缓解。19例甲氨蝶呤治疗失败的患者中，2例对VMP方案仍耐药，随后进行了FAV和EMP等多个疗程的挽救化疗，二线VMP组的缓解率为89.5%。无论是作为初次治疗还是补救治疗，对该方案的抵抗与治疗前较高的HCG明显相关。6 8例中4例（5 9%）出现3 ~ 4级严重骨髓抑制，其中无4级骨髓抑制。结论LR-GTN VMP方案是治疗白血病安全有效的方案，缓解率高。
ObjectiveTo evaluate the efficacy and toxicity of VMP regimen applied to the patients with low-risk gestational trophoblastic neoplasia (LR-GTN) treated in Anhui provincial hospital.Materials and methodsBetween 2005 and 2017, 87 patients with low-risk gestational trophoblastic neoplasia received VMP regimen, consisted of vincristine (VCR), methotrexate (MTX) and platinum (cisplatin, carboplatin or nedaplatin), 68 of whom received VMP as their first-line chemotherapy, and 19 methotrexate-failed patients received VMP regimen as their second-line chemotherapy. The staging and scoring system was based on International Federation of Gynecology and Obstetrics (FIGO 2000) criteria. We describe and analyze their baseline characteristics, remission/resistance/recurrence rates, adverse reactions and prognosis.ResultsThe first-line VMP protocol can achieve an 83.8% remission rate and it tended to develop resistance when the pretreatment β-hCG reaches 7503.5 IU/L, and can achieve complete remission with FAV and EMA-CO as the salvage regimen. Among the 19 methotrexate-failed patients, 2 of whom were yet resistant to VMP regimen, followed by several courses of salvage chemotherapy such as FAV and EMP, and achieved 89.5% remission rate in second-line VMP group. Resistance to this regimen was obviously related with higher pre-treatment HCG whether used as primary or salvage treatment. Severe myelosuppression (grade 3 or 4) was shown in 4 (5.9%) of 68 cases, of which none was grade 4.ConclusionFor patients diagnosed with LR-GTN VMP regimen was a safe and effective treatment with a high rate of remission.