Singer J M, Mijovic A, Pettingale K W, Nethersell A, Dobbs H J, Samaratunga I R, Lakhani A, Mufti G J
Kings College Hospital, London, UK.
Clin Oncol (R Coll Radiol). 1995;7(6):366-70. doi: 10.1016/s0936-6555(05)80006-8.
We performed a retrospective analysis on 45 patients who, between January 1989 and October 1993, received VAPEC-B chemotherapy for high and intermediate grade non-Hodgkin's lymphoma. The aim was to assess response and tolerance to treatment. The weekly regimen consisted of: doxorubicin 35 mg/m2 i.v. weeks 1,3,5,7,9,11; cyclophosphamide 350 mg/m2 i.v. weeks 1, 5, 9; etoposide 100 mg/m2 p.o. daily for 5 days, weeks 3, 7, 11; vincristine 1.4 mg/m2 i.v. (2 mg max.) weeks 2, 4, 6, 8, 10; bleomycin 10 mg/m2 i.v. weeks 2, 6, 10; methotrexate 12.5 mg i.t. weeks 1, 5, 9; prednisolone 50 mg p.o. daily for 6 weeks, reduced to 25 mg daily for 6 weeks. The patients treated were aged 22-71 years, 34 (75%) had high grade (Working Formulation) non-Hodgkin's lymphoma (NHL); 11 (24%) had intermediate grade NHL; 25 had Stage III/IV disease; and 14 (31%) had marrow involvement. The majority of patients (76%) received VAPEC-B as first line chemotherapy; the remainder received it for relapsing disease. Follow-up time from completion of VAPEC-B chemotherapy ranged from 6 months to 50 months (median 25). VAPEC-B, as first line therapy, induced a complete response (CR) and partial response (PR) in 79% and 18% respectively, whilst 3% had no response to treatment. VAPEC-B used for relapsing disease produced CR and PR in 64% and 27% respectively, whilst 9% failed to respond. Six patients in PR and five patients in CR have subsequently undergone an autologous bone marrow transplant or a peripheral blood stem cell transplant. In the group who received VAPEC-B first line but did not proceed to transplant (27 patients), five relapsed (three with CNS disease who had not had CNS prophylaxis). Tolerance to treatment was measured by WHO toxicity scores. The haemoglobin (Hb) toxicity median score for all patients was grade 1 (Hb 9.5-10.9 g/dl), and the white cell count (WCC), toxicity score was grade 2 (WCC 2.0-2.9 x 10(9)/l). No platelet toxicity was observed. Ten per cent of patients suffered grade 3 severity infections requiring antibiotics and there was one treatment related death. The majority of patients received VAPEC-B on time, however, 24% patients had a 2-week delay. VAPEC-B chemotherapy is an effective regimen for malignant lymphoma, either as a first line or as a salvage treatment. Although chemotherapy was given weekly, the tolerance to treatment was acceptable, thus making this short regimen a good alternative to CHOP chemotherapy.
我们对1989年1月至1993年10月期间接受VAPEC - B化疗的45例高中度非霍奇金淋巴瘤患者进行了回顾性分析。目的是评估治疗反应和耐受性。每周治疗方案包括：阿霉素35mg/m²静脉注射，第1、3、5、7、9、11周；环磷酰胺350mg/m²静脉注射，第1、5、9周；依托泊苷100mg/m²口服，每日1次，共5天，第3、7、11周；长春新碱1.4mg/m²静脉注射（最大2mg），第2、4、6、8、10周；博来霉素10mg/m²静脉注射，第2、6、10周；甲氨蝶呤12.5mg鞘内注射，第1、5、9周；泼尼松龙50mg口服，每日1次，共6周，之后减至25mg每日1次，共6周。接受治疗的患者年龄在22 - 71岁之间，34例（75%）为高级别（工作分类法）非霍奇金淋巴瘤（NHL）；11例（24%）为中级别NHL；25例为Ⅲ/Ⅳ期疾病；14例（31%）有骨髓受累。大多数患者（76%）接受VAPEC - B作为一线化疗；其余患者用于复发性疾病。VAPEC - B化疗结束后的随访时间为6个月至50个月（中位时间25个月）。作为一线治疗，VAPEC - B分别诱导79%的患者完全缓解（CR）和18%的患者部分缓解（PR），而3%的患者对治疗无反应。用于复发性疾病的VAPEC - B分别产生64%的CR和27%的PR，而9%的患者无反应。6例PR患者和5例CR患者随后接受了自体骨髓移植或外周血干细胞移植。在接受一线VAPEC - B但未进行移植的组（27例患者）中，5例复发（3例有中枢神经系统疾病且未进行中枢神经系统预防）。通过WHO毒性评分来衡量治疗耐受性。所有患者血红蛋白（Hb）毒性中位评分为1级（Hb 9.5 - 10.9g/dl），白细胞计数（WCC）毒性评分为2级（WCC 2.0 - 2.9×10⁹/l）。未观察到血小板毒性。10%的患者发生3级严重感染需要使用抗生素，有1例与治疗相关的死亡。大多数患者按时接受VAPEC - B治疗，然而，24%的患者有2周的延迟。VAPEC - B化疗无论是作为一线治疗还是挽救治疗，都是恶性淋巴瘤的有效方案。尽管化疗每周进行，但治疗耐受性是可以接受的，因此使这个短疗程方案成为CHOP化疗的一个良好替代方案。
