Xu Wei, Li Jian-Yong, Qian Si-Xuan, Wu Han-Xin, Lu Hua, Chen Li-Juan, Zhang Su-Jiang, Lu Rui-Lan, Sheng Rui-Lan
Department of Hematology, The First Affiliated Hospital of Nanjing Medical University, Jiangsu Province Hospital, 300 Guangzhou Road, Nanjing 210029, China.
Leuk Res. 2008 Jun;32(6):930-5. doi: 10.1016/j.leukres.2007.10.019. Epub 2007 Dec 3.
Modern intensive chemotherapy regimens have improved the prognosis for adult patients with acute lymphocytic leukemia (ALL). With these regimens, the complete response (CR) rates are approximately 75% and long-term disease-free survival (DFS) rates are about 20-35%. For patients with high-risk ALL, DFS rates are only 20% or less. Hyper-CVAD regimen is effective in ALL and aggressive non-Hodgkin lymphomas (NHL) with increased CR rates and DFS rates. Between June 2002 and October 2006, 53 consecutive adult patients with newly diagnosed adult ALL were treated with Hyper-CVAD regimen for six to eight cycles. The alternating courses were given every 3-4 weeks or earlier if count recovery occurred. CR rates of 73.6% were achieved in 39 patients, the estimated 2-year survival rate was 82.9% and the estimated 2-year event-free survival (EFS) rate was 87.3%. Side effects were as expected, mostly attributed to myelosuppression. Analysis of prognostic factors suggested that some previously well-established poor prognostic factors such as the degree of leukocytosis and central nervous system (CNS) or testicular involvement were less important with this dose-intensive regimen. However, patients with mediastinal disease had lower CR rates (P<0.05), with the presence of hepatomegaly and t(9;22) abnormalities had poor survival (P<0.05). Compared with other established adult ALL regimens, Hyper-CVAD regimen was associated with significantly better CR rates, overall survival and EFS rates. The long-term follow-up results of Hyper-CVAD were favorable.
现代强化化疗方案改善了成人急性淋巴细胞白血病（ALL）患者的预后。采用这些方案，完全缓解（CR）率约为75%，长期无病生存率（DFS）约为20% - 35%。对于高危ALL患者，DFS率仅为20%或更低。Hyper - CVAD方案对ALL和侵袭性非霍奇金淋巴瘤（NHL）有效，可提高CR率和DFS率。在2002年6月至2006年10月期间，53例新诊断的成人ALL患者连续接受Hyper - CVAD方案治疗6至8个周期。交替疗程每3 - 4周进行一次，若血细胞计数恢复则提前进行。39例患者的CR率达到73.6%，估计2年生存率为82.9%，估计2年无事件生存率（EFS）为87.3%。副作用如预期，主要归因于骨髓抑制。预后因素分析表明，一些先前确定的不良预后因素，如白细胞增多程度以及中枢神经系统（CNS）或睾丸受累情况，在这种剂量密集型方案中不太重要。然而，纵隔疾病患者的CR率较低（P<0.05），有肝肿大和t(9;22)异常的患者生存率较差（P<0.05）。与其他已确立的成人ALL方案相比，Hyper - CVAD方案的CR率、总生存率和EFS率显著更好。Hyper - CVAD方案的长期随访结果良好。
