Broun E R, Tricot G, Akard L, Nichols C, Cheerva A, Jansen J
Indiana University Hospital, Indianapolis 46202-5250.
Bone Marrow Transplant. 1990 May;5(5):341-4.
This study was designed to test the efficacy and toxicity of combining high-dose cytarabine (3 g/m2 every 12 h x 8 doses day -7 to day -4, total dose 24 g/m2), methyl prednisolone (0.5 mg/kg every 4 h day -7 to day -1), and cyclophosphamide (CY) (60 mg/kg day -3 and day -2) with either total body irradiation (TBI) (900 cGy in a single fraction on day -1) or VP-16 (600 mg/m2/days -7, -5, and -3) in patients not eligible for TBI secondary to prior radiotherapy. We treated 14 patients (eight male, six female) with either non-Hodgkin's lymphoma (n = 5) or Hodgkin's disease (n = 9). All patients had failed prior conventional chemotherapy (median two regimens range 1-5). Five patients were treated with TBI and nine with VP-16. There were eight complete remissions, two partial remissions, four were inevaluable for response due to early death. Overall survival is 21% (3/14) and relapse-free survival is 7% (1/14) with the sole disease-free survivor now 40 months from transplant. Very significantly, among patients receiving TBI, there were no survivors (median survival 24 days, range 17-330 days) and 4/5 had pulmonary complications. Median DLCO in these four patients was 61% (range 50-67) prior to transplant and none had an infectious etiology established by bronchoalveolar lavage. Median time to an absolute granulocyte count of 500 x 10(6)/l was 16 days (range 10-37 days) and to a platelet count of 20 x 10(9)/l was 12 days (range 7-22 days). In conclusion, the addition of high-dose cytarabine (24 g/m2) to CY and single-dose TBI or VP-16, while being very active, produced excessive pulmonary toxicity in this group of patients with lymphoma.
本研究旨在测试对于因既往接受过放疗而不符合全身照射（TBI）条件的患者，将大剂量阿糖胞苷（每12小时3 g/m²，共8剂，第-7天至第-4天，总剂量24 g/m²）、甲泼尼龙（第-7天至第-1天，每4小时0.5 mg/kg）和环磷酰胺（CY）（第-3天和第-2天，60 mg/kg）与TBI（第-1天单次给予900 cGy）或依托泊苷（VP-16）（第-7天、-5天和-3天，600 mg/m²/天）联合使用时的疗效和毒性。我们治疗了14例患者（8例男性，6例女性），其中非霍奇金淋巴瘤患者5例，霍奇金病患者9例。所有患者既往常规化疗均失败（中位两种方案，范围1 - 5种）。5例患者接受了TBI治疗，9例接受了VP-16治疗。有8例完全缓解，2例部分缓解，4例因早期死亡无法评估疗效。总体生存率为21%（3/14），无复发生存率为7%（1/14），唯一无病生存者目前移植后已40个月。非常显著的是，在接受TBI的患者中，无幸存者（中位生存期24天，范围17 - 330天），4/5有肺部并发症。这4例患者移植前的中位一氧化碳弥散量（DLCO）为61%（范围50 - 67），经支气管肺泡灌洗均未确定感染病因。绝对粒细胞计数达到500×10⁶/l的中位时间为16天（范围10 - 37天），血小板计数达到20×10⁹/l的中位时间为12天（范围7 - 22天）。总之，在CY和单次剂量TBI或VP-16基础上加用大剂量阿糖胞苷（24 g/m²），虽然活性很强，但在这组淋巴瘤患者中产生了过度的肺部毒性。
