Kantarjian H M, Keating M J, Walters R S, Koller C A, McCredie K B, Freireich E J
Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030.
Cancer. 1989 Mar 1;63(5):813-7. doi: 10.1002/1097-0142(19890301)63:5<813::aid-cncr2820630502>3.0.co;2-v.
Thirty-one patients with a diagnosis of refractory acute myelogenous leukemia received homoharringtonine as their first (15 patients) or second (16 patients) salvage therapy. Homoharringtonine was given as a continuous infusion of 2.5 mg/m2 daily for 15 to 21 days to 13 patients (schedule 1), and of 3.0 mg/m2 daily for 15 days in 18 patients (schedule 2). Overall, one patient achieved complete remission (3%), and three (10%) had a hematologic improvement with normalization of the marrow and peripheral blood picture except for persistent thrombocytopenia. Six patients (19%) demonstrated prolonged myelosuppression, three (23%) on schedule 1 and three (17%) on schedule 2. Cardiovascular complications were minimal consisting of hypotension in one patient (3%) and supraventricular arrhythmias in two patients (6%). Hyperglycemia was observed in 42% of patients and was significant in 10%. The authors conclude that homoharringtonine, at the dose schedule investigated, has definite but low antileukemic efficacy. The low-dose continuous infusion schedule was associated with prolonged myelosuppression but no serious cardiovascular complications. The role of such therapy in myeloproliferative disorders, especially chronic myelogenous leukemia, deserves consideration.
31例诊断为难治性急性髓性白血病的患者接受高三尖杉酯碱作为首次（15例）或第二次（16例）挽救治疗。13例患者（方案1）接受高三尖杉酯碱持续静脉输注，剂量为2.5mg/m²，每日1次，共15至21天；18例患者（方案2）接受高三尖杉酯碱持续静脉输注，剂量为3.0mg/m²，每日1次，共15天。总体而言，1例患者获得完全缓解（3%），3例（10%）患者血液学改善，骨髓和外周血象恢复正常，但血小板持续减少。6例患者（19%）出现骨髓抑制延长，方案1中有3例（23%），方案2中有3例（17%）。心血管并发症极少，1例患者（3%）出现低血压，2例患者（6%）出现室上性心律失常。42%的患者观察到高血糖，10%的患者高血糖较为显著。作者得出结论，在所研究的剂量方案下，高三尖杉酯碱具有确切但较低的抗白血病疗效。低剂量持续静脉输注方案与骨髓抑制延长相关，但无严重心血管并发症。这种治疗方法在骨髓增殖性疾病，尤其是慢性髓性白血病中的作用值得考虑。
