Roncadin M, Arcicasa M, Bortolus R, Trovó M G, Carbone A, Tirelli U, De Paoli A, Franchin G, Grigoletto E
Department of Radiotherapy, C.R.O., Aviano, Italy.
Cancer Invest. 1991;9(4):403-7. doi: 10.3109/07357909109084637.
Combined total body irradiation (TBI) and Prednimustine were prospectively evaluated in 30 patients affected either with chronic lymphocytic leukemia (CLL) or with low-grade non-Hodgkin's lymphoma (NHL) eleven patients were previously treated. Between January 1984 and May 1987, 20 evaluable patients with CLL, median age 66 years (range 43-82), classified according to Rai (4 in stage I, 10 in stage II, 4 in stage III, 2 in stage IV) and 10 evaluable patients with NHL low-grade malignancy according to the Working Formulation, Stages III and IV, median age 54 years (range 32-71) were treated using a 6 MeV Linear Accelerator, applying two opposite alternating fields including total body, with a fraction of 15 cGy, 2 fractions weekly (3-day interval) for a total dose of 150 cGy given over 5 weeks. Prednimustine (100 mg/m2, orally, for 5 consecutive days, every 3-4 weeks, for 6-9 courses) was administered 2 months after TBI treatment, as consolidation therapy. By May 1989, a total of 85% hematological responses (defined as normalization of the differential white cell count, of the total blood cell count and of bone marrow infiltration) were obtained after combined treatment in CLL patients; moreover 3 CR (according to the WHO criteria), 75% with splenomegaly reduction and 40% with lymphadenopathy reduction were seen. Ninety percent objective responses (5 CR and 4 PR) were observed in the NHL patients, with 50% having splenomegaly reduction and 67% lymphadenopathy reduction. The median response time in the two groups was, respectively, 14 and 23 months. The overall toxicity (WHO grades 1,2,3,4) after combined treatment was 65% and 70% in the two patient groups. WHO grade III toxicity, completely reversible, was verified in only 16.6% of the cases; all cases, except one, were previously treated. Additionally, 1 toxic death (grade IV thrombocytopenia and leukopenia) was observed in a heavily pretreated patient affected with CLL after TBI alone. Prednimustine regimen was generally well tolerated. The high response rate and acceptable toxicity, confirms the feasibility and the usefulness of TBI in the context of a combined treatment for CLL and low-grade NHL patients. However in order to further reduce the severe toxic side effects, observed in one patient, white blood cells and platelet count should be plotted and monitored carefully, particularly in pretreated patients.
对30例慢性淋巴细胞白血病（CLL）或低度非霍奇金淋巴瘤（NHL）患者进行了全身照射（TBI）联合泼尼松氮芥的前瞻性评估，其中11例患者曾接受过治疗。1984年1月至1987年5月，对20例可评估的CLL患者（中位年龄66岁，范围43 - 82岁）进行治疗，这些患者根据Rai分期（I期4例，II期10例，III期4例，IV期2例）；以及10例可评估的低度恶性NHL患者（根据工作分类法为III期和IV期，中位年龄54岁，范围32 - 71岁）进行治疗。使用6 MeV直线加速器，采用两个相对的交替野包括全身，每次分割剂量为15 cGy，每周2次（间隔3天），共5周给予总剂量150 cGy。TBI治疗2个月后给予泼尼松氮芥（100 mg/m²，口服，连续5天，每3 - 4周一次，共6 - 9个疗程）作为巩固治疗。到1989年5月，CLL患者联合治疗后共获得85%的血液学缓解（定义为白细胞分类计数、全血细胞计数和骨髓浸润正常化）；此外，观察到3例完全缓解（根据WHO标准），75%的患者脾肿大减轻，40%的患者淋巴结肿大减轻。NHL患者观察到90%的客观缓解（5例完全缓解和4例部分缓解），50%的患者脾肿大减轻，67%的患者淋巴结肿大减轻。两组的中位缓解时间分别为14个月和23个月。联合治疗后两组的总体毒性（WHO 1、2、3、4级）分别为65%和70%。仅16.6%的病例证实有完全可逆的WHO III级毒性；除1例患者外，所有病例均曾接受过治疗。此外，1例接受过大量预处理的CLL患者在仅接受TBI治疗后发生1例毒性死亡（IV级血小板减少和白细胞减少）。泼尼松氮芥方案总体耐受性良好。高缓解率和可接受的毒性证实了TBI在CLL和低度NHL患者联合治疗中的可行性和有效性。然而，为了进一步减少在1例患者中观察到的严重毒副作用，应仔细绘制和监测白细胞和血小板计数，特别是在预处理患者中。
