全剂量长春新碱（无2毫克剂量限制）用于淋巴瘤治疗。

Full dose vincristine (without 2-mg dose limit) in the treatment of lymphomas.

作者信息

Haim N, Epelbaum R, Ben-Shahar M, Yarnitsky D, Simri W, Robinson E

机构信息

Department of Oncology, Rambam Medical Center, Haifa, Israel.

出版信息

Cancer. 1994 May 15;73(10):2515-9. doi: 10.1002/1097-0142(19940515)73:10<2515::aid-cncr2820731011>3.0.co;2-g.

DOI:10.1002/1097-0142(19940515)73:10<2515::aid-cncr2820731011>3.0.co;2-g

PMID:8174048

Abstract

BACKGROUND

Most current lymphoma protocols limit vincristine dose to 2 mg per single dose. Because a lower dose of vincristine may be associated with poorer outcome, there is some rationale to increase the dose of vincristine.

METHODS

The feasibility of full dose vincristine (i.e., 1.4 mg/m2 without 2-mg dose limit) was prospectively evaluated in lymphoma patients treated with various combinations. After an initial dose of 1.4 mg/m2, patients were carefully monitored, and dose was modified according to toxicity.

RESULTS

One hundred and four consecutive patients (31 with Hodgkin's disease and 73 with non-Hodgkin's lymphoma), aged 18-78 years were evaluated. The first dose was greater than 2 mg in 90% of the patients. The mean actual dose (percent of projected dose) was 100% in the first course and gradually decreased to 64% in the eighth course. The mean actual dose intensity of vincristine (percent of projected dose intensity) during the initial six cycles of prednisone, methotrexate, calcium leucovorin, doxorubicin, cyclophosphamide, etoposide, and mechlorethamine, vincristine, procarbazine, prednisone (ProMACE/MOPP), cyclophosphamide, doxorubicin, vincristine, and prednisone (CHOP), and MOPP/doxorubicin, bleomycin, and vinblastine (MOPP/ABV) was 82% and MOPP/doxorubicin, bleomycin, and vinblastine was 82%, 83%, and 87%, respectively. Symptoms of neuropathy developed in 92% of the patients and were usually of mild or moderate severity. Toxicity included World Health Organization (WHO) Grades 3 and 4 constipation in 10 (10%), and WHO Grade 3 peripheral neurotoxicity in 16 (15%) patients. Rapid improvement was usually noticed within a few weeks after withdrawal of vincristine. The median duration of symptoms from discontinuation of vincristine was 3 months for paresthesiae and motor weakness and 5 months for muscle cramps.

CONCLUSIONS

Full dose vincristine in lymphoma protocols is feasible but is associated with increased toxicity. The therapeutic advantage of full dose vincristine has yet to be proven.

摘要

背景

目前大多数淋巴瘤治疗方案将长春新碱单次剂量限制在2毫克。由于较低剂量的长春新碱可能与较差的治疗结果相关，因此有理由增加长春新碱的剂量。

方法

前瞻性评估了全剂量长春新碱（即1.4毫克/平方米，无2毫克剂量限制）在接受各种联合治疗的淋巴瘤患者中的可行性。初始剂量为1.4毫克/平方米后，对患者进行密切监测，并根据毒性调整剂量。

结果

评估了104例连续患者（31例霍奇金病患者和73例非霍奇金淋巴瘤患者），年龄在18至78岁之间。90%的患者首剂剂量大于2毫克。首疗程的平均实际剂量（预计剂量的百分比）为100%，至第八疗程逐渐降至64%。在泼尼松、甲氨蝶呤、亚叶酸钙、阿霉素、环磷酰胺、依托泊苷、氮芥、长春新碱、丙卡巴肼、泼尼松（ProMACE/MOPP）、环磷酰胺、阿霉素、长春新碱和泼尼松（CHOP）以及MOPP/阿霉素、博来霉素和长春花碱（MOPP/ABV）的初始六个周期中，长春新碱的平均实际剂量强度（预计剂量强度的百分比）分别为82%、83%和87%。92%的患者出现神经病变症状，通常为轻度或中度。毒性包括10例（10%）患者出现世界卫生组织（WHO）3级和4级便秘，16例（15%）患者出现WHO 3级周围神经毒性。停用长春新碱后通常在几周内即可观察到症状迅速改善。长春新碱停药后感觉异常和运动无力症状的中位持续时间为3个月，肌肉痉挛症状的中位持续时间为5个月。