霍奇金淋巴瘤患者ABVD化疗前后的肺弥散容量变化
Diffusion Lung Capacity Changes In Hodgkin Lymphoma Patients Before And After Abvd Chemotherapy.
作者信息
Abdullah Muhammad, Alam Shoaib, Zafar Waleed, Majid Abdul
机构信息
Department of Internal Medicine, Shaukat Khanum Memorial Cancer Hospital and Research Centre Lahore, Pakistan.
Department of Internal Medicine.
出版信息
J Ayub Med Coll Abbottabad. 2016 Apr-Jun;28(2):289-292.
BACKGROUND
Chemotherapy consisting of Adriamycin, Bleomycin, Vinblastine, and Doxorubicin (ABVD), which is the mainstay of treatment in Hodgkin's Lymphoma (HL), is associated with both acute and long-term pulmonary toxicity primarily due to Bleomycin. Bleomycin induced pulmonary toxicity (BPT) is clinically detected using diffusing lung capacity for carbon monoxide (DLCO). The objective of this study was to evaluate changes in DLCO in HL patients before and after ABVD chemotherapy.
METHODS
Medical records of all adult HL patients treated with ABVD chemotherapy at a single centre in Lahore, Pakistan during the entire calendar year 2012 were analysed. Patients with pre-existing pulmonary dysfunction, history of thoracic surgery and smokers were excluded.
RESULTS
A total of 179 HL patients were identified during the study period who received ABVD chemotherapy. Out of these, 93 (51.95%) patients had undergone both a pre- and post-chemotherapy DLCO measurements. The remaining patients had only one DLCO reading available and were not included in the analysis. The mean percentage difference between pre- and post-chemotherapy values for DLCO (5.49%; 95% confidence interval [CI] 1.56-9.43%) and for Haemoglobin-adjusted DLCO (8.24%; 95% CI 3.90-12.57%) were statistically significant at p<0.01. Diffusing lung capacity for carbon (DLCO) values declined from pre-treatment to post-treatment by 1-10% in 23 (24.7%) patients, by 10-20% in 19 (20.4%) patients, by 20-30% in 10 (10.8%) patients and >30% in 10 (10.8%) patients. After adjusting for age, a 1mg/m2 increase in dose of Bleomycin was significantly associated with 0.14% (95% CI: 0.03-0.25%) decline in DLCO and 0.13% (95% CI: 0.10-0.26%) decline in haemoglobin-adjusted DLCO from pre-treatment value.
CONCLUSIONS
Mild to moderate dysfunction in diffusion lung capacity is common after ABVD chemotherapy. DLCO and haemoglobin-adjusted DLCO value decreased with increasing age and increasing dose of Bleomycin.
背景
由阿霉素、博来霉素、长春花碱和多柔比星组成的化疗方案（ABVD）是霍奇金淋巴瘤（HL）治疗的主要方法，该方案与急性和长期肺部毒性相关，主要原因是博来霉素。临床上通过一氧化碳弥散肺容量（DLCO）检测博来霉素诱导的肺毒性（BPT）。本研究的目的是评估HL患者在接受ABVD化疗前后DLCO的变化。
方法
分析了2012年全年在巴基斯坦拉合尔一个中心接受ABVD化疗的所有成年HL患者的病历。排除已有肺功能障碍、有胸外科手术史和吸烟者。
结果
在研究期间共确定了179例接受ABVD化疗的HL患者。其中，93例（51.95%）患者在化疗前后均进行了DLCO测量。其余患者仅有一次DLCO读数，未纳入分析。化疗前后DLCO值的平均百分比差异（5.49%；95%置信区间[CI]1.56 - 9.43%）以及血红蛋白校正后的DLCO值的平均百分比差异（8.24%；95%CI 3.90 - 12.57%）在p<0.01时具有统计学意义。23例（24.7%）患者的碳弥散肺容量（DLCO）值从治疗前到治疗后下降了1 - 10%，19例（20.4%）患者下降了10 - 20%，10例（10.8%）患者下降了20 - 30%，10例（10.8%）患者下降超过30%。在调整年龄后，博来霉素剂量每增加1mg/m²，DLCO较治疗前值显著下降0.14%（95%CI：0.03 - 0.25%），血红蛋白校正后的DLCO下降0.13%（95%CI：0.10 - 0.26%）。
结论
ABVD化疗后轻度至中度弥散肺容量功能障碍较为常见。DLCO和血红蛋白校正后的DLCO值随年龄增长和博来霉素剂量增加而降低。
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