Avilés A, Guzmán R, Delgado S, Nambo M J, García E L, Díaz-Maqueo J C
Department of Hematology, Oncology Hospital, National Medical Center, México, D.F. Mexico.
Am J Hematol. 1996 Aug;52(4):275-80. doi: 10.1002/(SICI)1096-8652(199608)52:4<275::AID-AJH6>3.0.CO;2-P.
An intensive brief chemotherapy and radiotherapy regimen including high doses of cyclo-phosphamide (5 g/m2), etoposide (1 g/m2), epirubicin (180 mg/m2), and ifosfamide (5 g/m2) administered in a period of 30 days followed by involved field radiotherapy to sites of initial bulky disease was administered to 46 untreated patients with high-intermedium and high-risk malignant lymphoma. G- or GM-CSF were used as hematological support instead of bone marrow transplantation. All patients had more than 3 adverse prognostic factors at diagnosis. Forty-one patients (89%) achieve complete response (33 after chemotherapy and 8 partial responses were converted to complete response after adjuvant radiotherapy). Acturial failure-free survival at 3 years is 83% and 37 of all patients started on therapy remain alive and in first remission at a median of 24.3 months from completion of treatment. Nearly all patients developed granulocytopenia grade IV; only 13 episodes of bacterial infection were documented. Because hematological recovery was very short (mean 13.6 days) no death related treatment and opportunistic infections were observed. Other non-hematological toxicities were scarce and well tolerated. No decrease > 10% was observed in the left ventricular ejection fraction. None have developed clinically evident congestion heart failure or other late side effects. These results showed that G- or GM-CSF can act as hematological support instead of bone marrow transplantation during intensive and brief chemotherapy. These regimens produce higher complete remission rate, and adjuvant radiotherapy will improve the outcome in patients with bulky disease.
对46例未经治疗的高中危和高危恶性淋巴瘤患者实施了一种强化短程化疗和放疗方案，该方案包括在30天内给予高剂量的环磷酰胺（5 g/m²）、依托泊苷（1 g/m²）、表柔比星（180 mg/m²）和异环磷酰胺（5 g/m²），随后对最初大块病灶部位进行受累野放疗。使用粒细胞集落刺激因子（G-CSF）或粒细胞巨噬细胞集落刺激因子（GM-CSF）作为血液学支持，而非进行骨髓移植。所有患者在诊断时均有超过3个不良预后因素。41例患者（89%）达到完全缓解（化疗后33例，8例部分缓解在辅助放疗后转为完全缓解）。3年实际无失败生存率为83%，所有开始治疗的患者中有37例仍存活且处于首次缓解状态，自治疗结束起的中位时间为24.3个月。几乎所有患者均出现IV级粒细胞减少；仅记录到13次细菌感染发作。由于血液学恢复非常短暂（平均13.6天），未观察到与治疗相关的死亡和机会性感染。其他非血液学毒性较少且耐受性良好。左心室射血分数未观察到下降>10%。无人出现临床明显的充血性心力衰竭或其他晚期副作用。这些结果表明，在强化短程化疗期间，G-CSF或GM-CSF可作为血液学支持替代骨髓移植。这些方案产生更高的完全缓解率，辅助放疗将改善大块病灶患者的结局。
