Response duration and recovery of CD4+ lymphocytes following deoxycoformycin in interferon-α-resistant hairy cell leukemia: 7-year follow-up
Response duration and recovery of CD4+ lymphocytes following deoxycoformycin in interferon-α-resistant hairy cell leukemia: 7-year follow-up
复制标题
抗干扰素毛细胞白血病脱氧考福霉素后 CD4+ 淋巴细胞的反应持续时间和恢复：7 年随访
作者：
J. Seymour;M. Talpaz;R. Kurzrock
本文观察了α-干扰素（IFN- α）耐药的毛细胞白血病患者经脱氧共福霉素（DCF）治疗后的远期疗效，并探讨了淋巴细胞亚群恢复的动力学及影响恢复率的因素。1986年5月至1989年5月间，15例经组织学证实对IFN-α耐药的毛细胞白血病患者接受DCF 4 mg/m2，每2周一次，计划12个周期。所有15例患者的反应都是可评价的，并且从治疗开始后中位随访时间为88个月（范围，72至106个月）。14例患者对DCF有反应，均达到完全缓解（CR）（反应率93%; 95%置信区间，69%至100%）。7名患者在45至74个月后复发。使用Kaplan和Meier方法，中位缓解持续时间为74个月，在8年时，预计46%（95%置信区间，33%-59%）的患者将持续CR。7名复发患者对2-氯脱氧腺苷（2-CdA）治疗有反应，所有15名患者仍然活着。DCF后，CD 4+和CD 8+淋巴细胞计数的最低值显著低于治疗前（分别为P < 0.0001和P = 0.05），但在随访期间恢复至基线水平。达到CD 4+和CD 8+淋巴细胞正常范围下限的中位时间分别为54和36个月。与未行脾切除术的患者相比，既往行脾切除术的患者（n = 7）的基线CD 4+（P = 0.073）和CD 8+（P = 0.043）淋巴细胞计数更高，CD 4+（P = 0.027）和CD 8+淋巴细胞计数（P = 0.016）恢复更快。1例老年患者（年龄，78岁）被诊断为后续恶性肿瘤。未观察到晚期机会性感染。对IFN-α的耐药并不影响毛细胞白血病患者对DCF治疗的后续反应性。反应是持久的，没有长期后遗症的证据。CD 4+和CD 8+淋巴细胞亚群恢复缓慢，无免疫缺陷临床表现。脾切除患者的基线淋巴细胞计数似乎更高，DCF治疗后淋巴细胞恢复更快。
The long-term outcome of patients with hairy cell leukemia resistant to interferon-α (IFN- α) following treatment with deoxycoformycin (DCF) was examined, and the kinetics of recovery of lymphocyte subsets and factors influencing the rate of recovery investigated. Between May 1986 and May 1989, 15 patients with histologically confirmed hairy cell leukemia resistant to IFN-α received DCF 4 mg/m2 every 2 weeks with 12 cycles planned. All 15 patients were evaluable for response and have been followed for a median of 88 months (range, 72 to 106 months) from the start of therapy. Fourteen patients responded to DCF, all attaining complete remission (CR) (response rate 93%; 95% confidence interval, 69% to 100%). Seven patients have developed recurrent disease after 45 to 74 months. Using the method of Kaplan and Meier, the median remission duration is 74 months and, at 8 years, 46% (95% confidence interval, 33% to 59%) of patients are projected to be in ongoing CR. The seven relapsing patients have responded to treatment with 2-chlorodeoxyadenosine (2-CdA) and all 15 patients remain alive. After DCF, nadir CD4+ and CD8+ lymphocyte counts were significantly lower than prior to therapy (P < 0.0001 and P = 0.05, respectively), but returned to baseline levels during follow-up. Median times to attainment of the lower limit of the normal range of CD4+ and CD8+ lymphocytes were 54 and 36 months, respectively. Those patients who had previously undergone splenectomy (n = 7) had higher baseline CD4+ (P = 0.073) and CD8+ (P = 0.043) lymphocyte counts and more rapid recovery of both CD4+ (P = 0.027) and CD8+ lymphocyte counts (P = 0.016) than non-splenectomized patients. One elderly patient (age, 78 years) was diagnosed with subsequent malignancy. No late opportunistic infections were observed. Resistance to IFN-α does not impair subsequent responsiveness of patients with hairy cell leukemia to treatment with DCF. Responses are durable and without evidence of long-term sequelae. CD4+ and CD8+ lymphocyte subsets recover slowly without clinical manifestations of immunodeficiency. Splenectomized patients appear to have higher baseline lymphocyte counts and more rapid lymphocyte recovery following treatment with DCF.
喷司他汀治疗重组α-干扰素初始治疗失败的毛细胞白血病患者：CALGB 研究 8515 的报告。
影响因子：
11.4
作者：
Golomb,HM;Dodge,R;Mick,R;Budman,D;Hutchison,R;Horning,SJ;Schiffer,CA
通讯作者：
Schiffer,CA