Bonfante V, Viviani S, Devizzi L, Di Russo A, Di Nicola M, Magni M, Matteucci P, Grisanti S, Valagussa P, Bonadonna G, Gianni A M
Division of Medical Oncology C, Istituto Nazionale Tumori, Milan, Italy.
Eur J Haematol Suppl. 2001 Jul;64:51-5.
In an effort to improve results in patients with relapsed or refractory Hodgkin's disease (HD), an intensive regimen combining vinorelbine (25 mg/m2 i.v. days 1 and 5) and high-doses of ifosfamide (3000 mg/m2/d, days 1-4 by continuous infusion) with mesna uroprotection and G-CSF support was designed. Forty-seven patients were treated; 14 had failure to initial induction therapy and 33 had disease relapsed from an initial response. The response rate was 83%, with 21 complete (45%, CR) and 18 partial remissions (38%, PR). Partial response was achieved after a median of two cycles (range 1-3) and CR after a median of six cycles (range 2-10). At the end of ifosfamide and vinorelbine, 10 patients in CR, one in PR, and one with stable disease also received radiotherapy to nodal sites of relapse. Eleven patients who had undergone peripheral blood stem cell (PBSC) harvesting following ifosfamide-vinorelbine proceeded to receive high-dose chemotherapy (HDCT) and PBSC transplantation. The main toxic effect was grade III-IV neutropenia, documented in 65% of cycles with a median duration of 4 days, and non-haematological toxicity was mild. The combination of high-doses of ifosfamide and vinorelbine was well tolerated and an active regimen in treatment of patients with relapsed and refractory HD. It was not only useful as salvage therapy with or without consolidative radiotherapy but it also was a valuable induction regimen before high-dose intensification therapy followed by PBSC reinfusion in patients eligible for this approach.
为提高复发或难治性霍奇金淋巴瘤（HD）患者的治疗效果，设计了一种强化方案，该方案将长春瑞滨（第1天和第5天静脉注射25mg/m²）、高剂量异环磷酰胺（第1 - 4天持续静脉输注3000mg/m²/d）与美司钠尿路保护剂及粒细胞集落刺激因子（G - CSF）支持相结合。47例患者接受了治疗；14例对初始诱导治疗无效，33例疾病从初始缓解后复发。缓解率为83%，其中21例完全缓解（45%，CR），18例部分缓解（38%，PR）。部分缓解在中位2个周期（范围1 - 3个周期）后实现，完全缓解在中位6个周期（范围2 - 10个周期）后实现。在异环磷酰胺和长春瑞滨治疗结束时，10例完全缓解患者、1例部分缓解患者和1例病情稳定患者也接受了复发淋巴结部位的放射治疗。11例在接受异环磷酰胺 - 长春瑞滨治疗后进行了外周血干细胞（PBSC）采集的患者继续接受了大剂量化疗（HDCT）和PBSC移植。主要毒副作用为III - IV级中性粒细胞减少，在65%的周期中出现，中位持续时间为4天，非血液学毒性较轻。高剂量异环磷酰胺和长春瑞滨联合方案耐受性良好，是治疗复发和难治性HD患者的有效方案。它不仅作为有或无巩固性放疗的挽救治疗有用，而且对于适合这种方法的患者，在大剂量强化治疗及PBSC回输之前也是一种有价值的诱导方案。
