Telek Béla, Rejtó László, Kiss Attila, Batár Péter, Reményi Gyula, Rák Kálmán, Udvardy Miklós
Debreceni Orvos- és Egészségtudományi Centrum, II. Belgyógyászati Klinika, Hematológiai Tanszék.
Orv Hetil. 2002 Jun 16;143(24):1459-65.
Fludarabine is the most commonly used purine analog, its mechanism of action is complex. Fludarabine inhibits DNA synthesis, acts on non-dividing (G0 phase) cells influencing apoptosis.
PATIENTS, RESULTS, CONCLUSIONS: In our institute 47 patients were treated with fludarabine or fludarabine based combination chemotherapy. Fludarabine was given in 19 patients with chronic lymphocytic leukaemia (CLL), complete remission (CR) was achieved in one case, partial remission (PR) was obtained in 10 patients. Fludarabine was more effective in patients who received less intensive chemotherapy prior to fludarabine therapy and in those patients who had less advanced diseases. Elderly patients (over sixty years of age) also responded to fludarabine therapy. Fludarabine and cyclophosphamide combination (FCy) were used in three lymphocytic lymphoma patients, two of them obtained PR, in the third case the disease progressed. Fludarabine + mitoxantrone (Novantrone) + dexamethasone (FND) regimen was administered in nine patients who were previously heavily treated (one patient with B-CLL, one with T-CLL, one with peripheral T-cell lymphoma and six with indolent B-cell lymphoma). More patients and longer follow up is needed to determine the efficacy of FCy and FND protocol. FLAG-IDA (fludarabine, high dose Ara-C, granulocyte colony-stimulating factor, idarubicin) was applied in 16 acute leukaemia patients with poor prognosis including therapy refractory and relapsing cases. Three CR and two PR, one CR and three PR was achieved in nine patients with acute myeloid leukaemia and in seven patients with acute lymphoid leukaemia, respectively. For this reason, despite the short period of remission, this regimen can be recommended to patients who are candidate for stem cell transplantation.
氟达拉滨是最常用的嘌呤类似物，其作用机制复杂。氟达拉滨抑制DNA合成，作用于非分裂（G0期）细胞，影响细胞凋亡。
患者、结果、结论：在我们研究所，47例患者接受了氟达拉滨或基于氟达拉滨的联合化疗。19例慢性淋巴细胞白血病（CLL）患者接受了氟达拉滨治疗，1例达到完全缓解（CR），10例获得部分缓解（PR）。氟达拉滨在接受氟达拉滨治疗前化疗强度较低以及疾病进展程度较轻的患者中更有效。老年患者（60岁以上）对氟达拉滨治疗也有反应。3例淋巴细胞淋巴瘤患者使用了氟达拉滨和环磷酰胺联合方案（FCy），其中2例获得PR，第3例疾病进展。9例先前接受过大量治疗的患者（1例B-CLL、1例T-CLL、1例外周T细胞淋巴瘤和6例惰性B细胞淋巴瘤）采用了氟达拉滨+米托蒽醌（诺维本）+地塞米松（FND）方案。需要更多患者和更长时间的随访来确定FCy和FND方案的疗效。16例预后不良的急性白血病患者（包括治疗难治和复发病例）应用了FLAG-IDA（氟达拉滨、大剂量阿糖胞苷、粒细胞集落刺激因子、伊达比星）。9例急性髓细胞白血病患者和7例急性淋巴细胞白血病患者分别有3例CR和2例PR、1例CR和3例PR。因此，尽管缓解期较短，但该方案可推荐给适合干细胞移植的患者。
