Moreno Miriam, Sancho Juan-Manuel, Gardella Santiago, Coll Rosa, García Olga, Gallardo David, Ribera Josep-María
Servicio de Hematología Clínica, Institut Català d'Oncologia, Hospital Universitari Germans Trias i Pujol de Badalona, Universitat Autònoma de Barcelona, Barcelona, España.
Med Clin (Barc). 2010 Jan 30;134(2):72-5. doi: 10.1016/j.medcli.2009.05.042. Epub 2009 Nov 12.
Non-pegylated liposomal doxorubicin is associated with lower cardiac toxicity than conventional doxorubicin, and for that reason it has been used in the treatment of non-Hodgkin's lymphoma (NHL) in old patients or patients with cardiac disease. The objective of this study was to evaluate the efficacy and safety of chemotherapy schedules including non-pegylated liposomal doxorubicin in patients with NHL.
Retrospective study of NHL patients treated with non-pegylated liposomal doxorubicin in two hospitals. In each patient demographic data, clinical and biological variables, as well as therapy, response and toxicity were recorded.
Twenty-six patients were included, 14 (58%) of them were women. Median age was 76 years (range 42-86). The most frequent histological diagnosis was diffuse large B cell lymphoma (DLBCL, 20 patients). The stage disease at diagnosis was III/IV in 19 (73%) patients whereas 12 (57%) of the 21 patients with DLBCL and grade 3 follicular lymphoma had a high-risk International Prognostic Index. Three patients had a left ventricular ejection fraction lower than 50% at the time of starting treatment. The most frequent cardiovascular risk factor was hypertension (50% of the patients) and 6 (23%) had previous heart disease. In all cases non-pegylated liposomal doxorubicin was administered as part of the R-COMP schedule (rituximab, cyclophosphamide, vincristin, non-pegylated liposomal doxorubicin and prednisone), in 20 cases (73%) as first-line treatment and in the remaining 6 as salvage therapy. Two patients died after the first cycle of chemotherapy (one because of sudden death and the other due to disease progression). Eleven (61%) out of the 18 patients receiving R-COMP as first-line therapy achieved a complete response (CR), 5 (28%) achieved partial response (PR) and 2 showed progression. Only one out of the 6 patients receiving R-COMP as salvage therapy achieved CR, whereas 3 had PR and 2 did not respond. Grade 3 or 4 neutropenia was observed in 11 (46%) patients and febrile neutropenia in 10 (42%), while only one patient developed grade 4 thrombocytopenia. The median overall survival was 50,7 months (95% confidence interval [95% CI] 8-93.3) and the median disease free survival was 18,4 months (95% CI 18.1-18.7).
In this cohort of patients, most of them old and with cardiovascular risk factors, the administration of non-pegylated liposomal doxorubicin as part of R-COMP regimen was effective and safe.
与传统阿霉素相比，非聚乙二醇化脂质体阿霉素的心脏毒性较低，因此已用于老年患者或患有心脏病的非霍奇金淋巴瘤（NHL）患者的治疗。本研究的目的是评估包含非聚乙二醇化脂质体阿霉素的化疗方案对NHL患者的疗效和安全性。
对两家医院接受非聚乙二醇化脂质体阿霉素治疗的NHL患者进行回顾性研究。记录每位患者的人口统计学数据、临床和生物学变量，以及治疗、反应和毒性情况。
共纳入26例患者，其中14例（58%）为女性。中位年龄为76岁（范围42 - 86岁）。最常见的组织学诊断为弥漫性大B细胞淋巴瘤（DLBCL，20例患者）。确诊时19例（73%）患者为III/IV期疾病，而21例DLBCL和3级滤泡性淋巴瘤患者中有12例（57%）具有高危国际预后指数。3例患者在开始治疗时左心室射血分数低于50%。最常见的心血管危险因素是高血压（50%的患者），6例（23%）有既往心脏病史。在所有病例中，非聚乙二醇化脂质体阿霉素作为R - COMP方案（利妥昔单抗、环磷酰胺、长春新碱、非聚乙二醇化脂质体阿霉素和泼尼松）的一部分给药，20例（73%）作为一线治疗，其余6例作为挽救治疗。2例患者在化疗第一周期后死亡（1例因猝死，另1例因疾病进展）。18例接受R - COMP作为一线治疗的患者中有11例（61%）达到完全缓解（CR），5例（28%）达到部分缓解（PR），2例病情进展。6例接受R - COMP作为挽救治疗的患者中只有1例达到CR，3例有PR，2例无反应。11例（46%）患者出现3级或4级中性粒细胞减少，10例（42%）出现发热性中性粒细胞减少，而只有1例患者出现4级血小板减少。中位总生存期为50.7个月（95%置信区间[95%CI] 8 - 93.3），中位无病生存期为18.4个月（95%CI 18.1 - 18.7）。
在这组大多为老年且有心血管危险因素的患者中，将非聚乙二醇化脂质体阿霉素作为R - COMP方案的一部分给药是有效且安全的。
