Ioakimidis Leukothea, Patterson Christopher J, Hunter Zachary R, Soumerai Jacob D, Manning Robert J, Turnbull Barry, Sheehy Patricia, Treon Steven P
Bing Center for Waldenström's Macroglobulinemia, Dana-Farber Cancer Institute, Boston, MA 02115, USA.
Clin Lymphoma Myeloma. 2009 Mar;9(1):62-6. doi: 10.3816/CLM.2009.n.016.
Since the adoption of rituximab, the importance of doxorubicin and vincristine as treatment components remains to be clarified in Waldenström's macroglobulinemia (WM). We therefore examined the outcomes of symptomatic patients with WM who received CHOP-R (cyclophosphamide/doxorubicin/vincristine/prednisone plus rituximab; n = 23), CVP-R (cyclophosphamide/vincristine/ prednisone plus rituximab; n = 16), or CP-R (cyclophosphamide/prednisone plus rituximab; n = 19) at our institution. Baseline characteristics for all 3 cohorts were similar for age, previous therapies, bone marrow involvement, hematocrit, platelet count, and serum beta2-microglobulin, though serum immunoglobulin M levels were higher in patients treated with CHOP-R (P < or= .015). The overall response rates (ORR) and complete response (CR) rates to therapy were as follows: CHOP-R (ORR, 96%; CR, 17%); CVP-R (ORR 88%; CR 12%); CP-R (ORR, 95%; CR, 0%); P = not significant. Adverse events attributed to therapy showed a higher incidence for neutropenic fever and treatment-related neuropathy for CHOP-R and CVP-R versus CPR (P < .03). The results of this study demonstrate comparable responses among patients with WM receiving CHOP-R, CVP-R, or CP-R, though a significantly higher incidence of treatment-related neuropathy and febrile neutropenia was observed among patients treated with CVP-R and CHOP-R versus CP-R. The use of CP-R might provide analogous treatment responses to more intense cyclophosphamide-based regimens while minimizing treatment-related complications in patients with WM.
自采用利妥昔单抗以来，在华氏巨球蛋白血症（WM）中，阿霉素和长春新碱作为治疗成分的重要性仍有待阐明。因此，我们研究了在我院接受CHOP-R（环磷酰胺/阿霉素/长春新碱/泼尼松加利妥昔单抗；n = 23）、CVP-R（环磷酰胺/长春新碱/泼尼松加利妥昔单抗；n = 16）或CP-R（环磷酰胺/泼尼松加利妥昔单抗；n = 19）治疗的有症状WM患者的治疗结果。所有3个队列的基线特征在年龄、既往治疗、骨髓受累情况、血细胞比容、血小板计数和血清β2-微球蛋白方面相似，不过CHOP-R治疗的患者血清免疫球蛋白M水平更高（P≤0.015）。治疗的总缓解率（ORR）和完全缓解（CR）率如下：CHOP-R（ORR，96%；CR，17%）；CVP-R（ORR 88%；CR 12%）；CP-R（ORR，95%；CR，0%）；P = 无显著性差异。治疗引起的不良事件显示，与CP-R相比，CHOP-R和CVP-R的中性粒细胞减少性发热和治疗相关神经病变的发生率更高（P < 0.03）。本研究结果表明，接受CHOP-R、CVP-R或CP-R治疗的WM患者的反应相当，不过与CP-R相比，接受CVP-R和CHOP-R治疗的患者治疗相关神经病变和发热性中性粒细胞减少的发生率显著更高。使用CP-R可能为WM患者提供与更强烈的基于环磷酰胺的方案类似的治疗反应，同时将治疗相关并发症降至最低。
