La Rocca R V, Cooper M R, Stein C A, Kohler D, Uhrich M, Weinberger E, Myers C E
Clinical Pharmacology Branch, National Cancer Institute, Bethesda, Maryland.
Ann Oncol. 1992 Jul;3(7):571-3.
Ten patients with progressive follicular lymphomas (seven with follicular mixed lymphomas, three with follicular, small cleaved cell lymphomas) with clinical indications for systemic therapy received parenteral suramin. Each had failed from one to six prior chemotherapeutic regimens and three had in addition received prior radiation therapy. All had measurable disease and nine of the ten had documented bone marrow involvement at the start of therapy. Suramin was administered at an initial infusion rate of 350 mg/m2/day, which was then modified on the basis of subsequent weekly plasma suramin concentrations in order to reach a final plasma concentrations of 250-350 micrograms/ml. Treatment cycles were repeated at eight week intervals. Nine of ten patients are evaluable for response. Five of nine evaluable patients achieved a partial remission as defined by a greater than 50% decrease in the sum of the product of all measurable lesions. Sites of response include: Peripheral (five patients) and central (four patients) adenopathy, disappearance of biopsy-proven skin involvement (one patient), malignant pleural effusions (one patient) and shrinkage of an enlarged spleen (two patients). Disappearance of B symptoms occurred in the one responder with these symptoms. Response duration varied from 3 to 9 months (mean 5.6 months) with time to subsequent systemic therapy varying from 5 to 12 months (mean 8 months). Drug related toxicity included the development of polyradiculopathy (one case), liver function abnormalities (three cases), thrombocytopenia (five cases), vortex keratopathy (two cases) and bacterial infection (two cases). We conclude that suramin has significant activity against follicular lymphomas refractory to standard chemotherapy and that its precise role in the treatment of lymphoproliferative neoplasms in general warrants further investigation.
十例有全身治疗临床指征的进展期滤泡性淋巴瘤患者（七例为滤泡混合性淋巴瘤，三例为滤泡小裂细胞淋巴瘤）接受了静脉注射苏拉明治疗。每位患者之前接受过一至六种化疗方案均失败，其中三例还接受过放疗。所有患者疾病均具有可测量性，十例中有九例在治疗开始时记录有骨髓受累。苏拉明初始输注速率为350mg/m²/天，随后根据每周血浆苏拉明浓度进行调整，以使最终血浆浓度达到250 - 350μg/ml。治疗周期每八周重复一次。十例患者中有九例可评估疗效。九例可评估疗效的患者中有五例达到部分缓解，定义为所有可测量病灶乘积之和减少超过50%。缓解部位包括：外周淋巴结肿大（五例）和中央淋巴结肿大（四例）、经活检证实的皮肤受累消失（一例）、恶性胸腔积液（一例）以及肿大脾脏缩小（两例）。有B症状的一例缓解患者B症状消失。缓解持续时间为3至9个月（平均5.6个月），至后续全身治疗的时间为5至12个月（平均8个月）。药物相关毒性包括多发性神经根病（一例）、肝功能异常（三例）、血小板减少（五例）、涡状角膜病变（两例）和细菌感染（两例）。我们得出结论，苏拉明对标准化疗难治的滤泡性淋巴瘤具有显著活性，其在一般淋巴增殖性肿瘤治疗中的确切作用值得进一步研究。
