Ireland-Gill A, Espina B M, Akil B, Gill P S
Department of Internal Medicine, University of Southern California School of Medicine, Los Angeles.
Semin Oncol. 1992 Apr;19(2 Suppl 5):32-6; discussion 36-7.
Ninety-nine patients with advanced epidemic Kaposi's sarcoma were treated with bleomycin-containing regimens: 30 received bleomycin and vincristine (BV) and 69 received doxorubicin, bleomycin, and vincristine. Treatment regimens were well tolerated, with response rates ranging from 76% to 81%. However, neutropenia developed even with the relatively nonmyelotoxic BV regimen. Twenty-eight of the 99 patients (28%) were evaluated for pulmonary function prior to, during, and after completion of combination chemotherapy to assess pulmonary toxicity commonly associated with bleomycin. The carbon monoxide diffusion capacity (DLCO) was the only measurement that showed significant changes prior to and after completion of therapy (P = .0003). Moreover, patients receiving more than 100 cumulative units of bleomycin experienced significantly greater declines in DLCO measurements than those receiving lower cumulative doses (P = .0067). No patient, however, developed clinically significant pulmonary toxicity attributable to bleomycin, with individual cumulative bleomycin doses ranging from 10 to 313 U (median, 112 U). We conclude that bleomycin is active and safe in the treatment of Kaposi's sarcoma, and close monitoring of pulmonary function is warranted with cumulative doses exceeding 100 U.
99例晚期流行性卡波西肉瘤患者接受了含博来霉素的治疗方案：30例接受博来霉素和长春新碱（BV）治疗，69例接受阿霉素、博来霉素和长春新碱治疗。治疗方案耐受性良好，缓解率在76%至81%之间。然而，即使是相对非骨髓毒性的BV方案也出现了中性粒细胞减少。99例患者中有28例（28%）在联合化疗前、化疗期间和化疗结束后接受了肺功能评估，以评估与博来霉素相关的常见肺毒性。一氧化碳弥散量（DLCO）是唯一在治疗前和治疗后显示出显著变化的测量指标（P = .0003）。此外，接受超过100累积单位博来霉素的患者，其DLCO测量值的下降幅度明显大于接受较低累积剂量的患者（P = .0067）。然而，没有患者出现归因于博来霉素的具有临床意义的肺毒性，个体博来霉素累积剂量范围为10至313 U（中位数为112 U）。我们得出结论，博来霉素在治疗卡波西肉瘤方面有效且安全，对于累积剂量超过100 U的患者，有必要密切监测肺功能。
