氟达拉滨、环磷酰胺联合利妥昔单抗一线治疗43例慢性淋巴细胞白血病的临床分析
[Clinical analysis of fludarabine and cyclophosphamide combined with rituximab in the first-line treatment of 43 cases of chronic lymphoblastic leukemia].
作者信息
Wang T Y, Yi S H, Wang Y, Lyu R, Wang Q, Deng S H, Sui W W, Fu M W, Huang W Y, Liu W, An G, Zhao Y Z, Qiu L G
机构信息
State Key Laboratory of Experimental Hematology, National Clinical Research Center for Blood Diseases, Institute of Hematology & Blood Diseases Hospital, Chinese Academy of Medical Sciences & Peking Union Medical College, Tianjin 300020, China.
出版信息
Zhonghua Xue Ye Xue Za Zhi. 2021 Jul 14;42(7):543-548. doi: 10.3760/cma.j.issn.0253-2727.2021.07.003.
To investigate the efficacy of fludarabine and cyclophosphamide combined with rituximab (FCR) in previously untreated patients with chronic lymphocytic leukemia (CLL) . The clinical data of 43 enrolled patients from May 2004 to December 2017 were analyzed the efficacy and survival results. A total of 43 patients with 31 males and 12 females, and the median age was 58 years old (range 36 to72) before treatment. There were 8 patients with symptom B. The median number of peripheral blood lymphocyte was 26 (3-550) ×10(9)/L. IGHV unmutated was detected in 62.1% (18/29) patients, P53 deletion in 14% (6/43) patients, RB1 deletion in 18.6% (8/43) patients, Trisomy 12 in 25.6% (11/33) patients, ATM deletion in 16.7% (7/42) patients, respectively. The median number of treatment courses administered was 4 (range 2-6) . Twenty patients obtained CR (46.5%) , 18 patients obtained PR, 4 patients were SD, 1 patient was PD. The overall response rate (ORR) was 88.37%. Seven patients obtained MRD negative. After the median follow-up time of 51 (6-167) months, median PFS was 67 (29-105) months, median OS was not reach, 5-year PFS was (62.1±8.6) %, 10-year PFS was (31±14.3) %, 5-year OS was (70.5±8.3) %, and 10-year OS was (51.3±13.8) %. Less than 4 courses predicted adverse OS (<0.05) . P53 deletion and less than 4 courses were associated with poor PFS (<0.001) , and the prognostic value still remained after multivariate analysis[=7.65 (95% 1.74-33.60) , =0.007; =3.75 (95% 1.19-11.80) , =0.025]. Eighteen patients (41.9%) appeared grade 2-3 infection after chemotherapy, and 19 patients (44.2%) appeared grade 3-4 hematological adverse reactions. One patient (2.3%) was developed tumor lysis syndrome. All adverse reactions were controlled or recovered spontaneously. Previously untreated CLL patients treated with FCR had a high response rate and good survival rate, which is an important treatment choice for fit patients.
探讨氟达拉滨、环磷酰胺联合利妥昔单抗（FCR）方案治疗初治慢性淋巴细胞白血病（CLL）患者的疗效。分析2004年5月至2017年12月纳入的43例患者的临床资料，观察疗效及生存结果。43例患者中，男性31例，女性12例，治疗前中位年龄58岁（范围36至72岁）。有8例B症状患者。外周血淋巴细胞中位数为26（3至550）×10⁹/L。62.1%（18/29）的患者检测到IGHV未突变，14%（6/43）的患者检测到P53缺失，18.6%（8/43）的患者检测到RB1缺失，25.6%（11/33）的患者检测到12号染色体三体，16.7%（7/42）的患者检测到ATM缺失。中位治疗疗程数为4（范围2至6）。20例患者获得完全缓解（CR，46.5%），18例患者获得部分缓解，4例患者病情稳定，1例患者疾病进展。总缓解率（ORR）为88.37%。7例患者微小残留病检测为阴性。中位随访时间51（6至167）个月后，中位无进展生存期（PFS）为67（29至105）个月，中位总生存期（OS）未达到，5年PFS为（62.1±8.6）%，10年PFS为（31±14.3）%，5年OS为（70.5±8.3）%，10年OS为（51.3±13.8）%。少于4个疗程预示不良的总生存期（<0.05）。P53缺失和少于4个疗程与不良的无进展生存期相关（<0.001），多因素分析后预后价值仍然存在[=7.65（95% 1.74至33.60），=0.007；=3.75（95% 1.19至11.80），=0.025]。18例患者（41.9%）化疗后出现2至3级感染，19例患者（44.2%）出现3至4级血液学不良反应。1例患者（2.3%）发生肿瘤溶解综合征。所有不良反应均得到控制或自行恢复。初治CLL患者接受FCR方案治疗有较高的缓解率和良好的生存率，是适合患者的重要治疗选择。
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