Internal Medicine and Gastroenterology, University of Pavia, IRCCS Fondazione Policlinico S. Matteo, Pavia, Italy.
Crit Rev Oncol Hematol. 2012 Apr;82(1):18-24. doi: 10.1016/j.critrevonc.2011.04.003. Epub 2011 May 17.
The VBM (vinblastine, bleomycin, methotrexate) chemotherapy combined with involved-field radiotherapy in early-stage Hodgkin lymphoma has not become popular in spite of its excellent results. Nine small trials with this combined therapy were carried out and described in eleven reports. VBM+ radiotherapy offered complete remission rates of 94-100%, with 5-year progression-free survival of 75-95% (elderly patients included). Considerable pulmonary toxicity was recorded in the first trials, but was fully controlled in the later studies through slight modifications of the schedule. The pulmonary toxicity was found related to mediastinal radiotherapy, bleomycin dose and administration of chemotherapy after radiotherapy; it is mitigated by low doses of prednisone. The very good results, the abated side effects on the lungs, the low extrapulmonary toxicity, and the anthracycline-free formulation make this combination therapy worth considering for early-stage Hodgkin lymphoma, particularly in the case of mediastinal involvement or in elderly patients.
尽管 VBM（长春碱、博来霉素、甲氨蝶呤）化疗联合累及野放疗在早期霍奇金淋巴瘤中的疗效优异，但并未得到广泛应用。有 9 项小型试验采用了这种联合疗法，并在 11 份报告中进行了描述。VBM+放疗的完全缓解率为 94%-100%，5 年无进展生存率为 75%-95%（包括老年患者）。在最初的试验中记录到相当大的肺毒性，但通过对方案的轻微修改，在后来的研究中完全得到了控制。肺毒性与纵隔放疗、博来霉素剂量以及放疗后化疗的应用有关；小剂量泼尼松可减轻肺毒性。非常好的结果、减轻的肺部副作用、低的肺外毒性以及不含蒽环类药物的方案使这种联合疗法在早期霍奇金淋巴瘤中值得考虑，特别是在纵隔受累或老年患者的情况下。
