血液系统恶性肿瘤化疗方案的疗效：H-CVAD 与 GELA/BURKIMAB/PETHEMA LAL 方案的比较。

Efficacy of chemotherapy protocols for hematological malignancies: H-CVAD versus GELA/BURKIMAB/PETHEMA LAL.

机构信息

Hematology Department, Complejo Hospitalario Universitario de Albacete, Albacete, Spain.

Nephrology Department, Hospital Universitario Reina Sofía, Murcia, Spain.

出版信息

Exp Hematol. 2021 Sep;101-102:49-57. doi: 10.1016/j.exphem.2021.08.003. Epub 2021 Aug 14.

DOI:10.1016/j.exphem.2021.08.003

PMID:34403757

Abstract

The hyper-CVAD/methotrexate-cytarabine (H-CVAD/ MTX-AraC) chemotherapy protocol has been one of the standard treatments for hematological malignancies, such as mantle cell lymphoma (MCL), Burkitt lymphoma (BL), and B-cell and T-cell acute lymphoblastic leukemia. Because results of this therapy are poor, it has been progressively replaced with new specific regimens with better efficacy profiles (GELA protocol for MCL, BURKIMAB for BL, and PETHEMA for B-cell and T-cell acute lymphoblastic leukemia [ALL]). The objective of this study was to analyze the response rates and survival of these therapeutic regimens. This retrospective and descriptive observational study of 81 patients compared 42 patients treated with hyper-CVAD/methotrexate-cytarabine (group A) with 39 patients treated with GELA/BURKIMAB/PETHEMA (group B). More patients in group B than in group A completed the treatment (89.7% vs. 47.6%, p < 0.001). In group A, 14.3% did not complete treatment because of death compared with 7.7% in group B, and 29% in group A had cycle delays versus 6.7% in group B (p < 0.001). In group A, 78.6% of group A achieved a complete response (CR) compared with 94.9% of group B (p = 0.050). Disease-free survival (DFS) and overall survival (OS) were significantly higher in group B (p < 0.001 in both cases). Data for current therapeutic protocols have indicated superior efficacy, with higher complete response rates, as well as better disease-free survival and overall survival results. This article provides the best results in terms of the efficacy of treatment of four hematological malignancies (MCL, BL, B-cell ALL, and T-cell ALL) with the most current specific therapeutic regimens (GELA for MCL, BURKIMAB for BL, and PETHEMA for B-cell ALL and T-cell ALL) with respect to a classic general protocol (H-CVAD/MTX-AraC for all four). These results may represent a great advance in the treatment of these blood cancers, achieving an important long-term benefit for these hematological patients.

摘要

高剂量环磷酰胺/甲氨蝶呤-阿糖胞苷（H-CVAD/MTX-AraC）化疗方案一直是治疗血液系统恶性肿瘤（如套细胞淋巴瘤[MCL]、伯基特淋巴瘤[BL]和 B 细胞和 T 细胞急性淋巴细胞白血病）的标准治疗方法之一。由于该疗法的疗效不佳，因此已逐渐被具有更好疗效的新的特定方案所取代（GELA 方案用于 MCL、BURKIMAB 用于 BL 和 PETHEMA 用于 B 细胞和 T 细胞急性淋巴细胞白血病[ALL]）。本研究旨在分析这些治疗方案的反应率和生存率。这项对 81 例患者的回顾性和描述性观察性研究比较了 42 例接受高剂量环磷酰胺/甲氨蝶呤-阿糖胞苷（A 组）治疗的患者与 39 例接受 GELA/BURKIMAB/PETHEMA（B 组）治疗的患者。B 组中完成治疗的患者多于 A 组（89.7%比 47.6%，p<0.001）。A 组中，因死亡而未完成治疗的患者比例为 14.3%，而 B 组为 7.7%，A 组中有 29%的患者出现周期延迟，而 B 组仅为 6.7%（p<0.001）。A 组中，78.6%的患者达到完全缓解（CR），而 B 组中为 94.9%（p=0.050）。B 组的无病生存（DFS）和总生存（OS）显著更高（p<0.001）。目前的治疗方案数据表明，这些方案的疗效更好，完全缓解率更高，无病生存和总生存结果更好。本文提供了针对四种血液系统恶性肿瘤（MCL、BL、B 细胞 ALL 和 T 细胞 ALL）的当前最有效的特定治疗方案（针对 MCL 的 GELA、针对 BL 的 BURKIMAB 和针对 B 细胞 ALL 和 T 细胞 ALL 的 PETHEMA）的治疗效果的最佳结果，与经典的通用方案（所有四种肿瘤均使用 H-CVAD/MTX-AraC）相比。这些结果可能代表着这些血液癌症治疗的重大进展，为这些血液病患者带来了重要的长期获益。