摘要
目的比较VDLP（vincristine,daunorubicin,L-asparaginase or PEG-asparaginase,prednisone）方案中应用左旋门冬酰胺酶（L-asparaginase,L-Asp）和培门冬酶（polyethylene glycol conjugated asparaginase,PEG-Asp）诱导治疗成人急性淋巴细胞白血病（acute lymphoblastic leukemia,ALL）的疗效和安全性。方法回顾性分析我院2008年1月至2015年3月121例初治成人ALL患者临床资料,其中PEG-Asp组46例,L-Asp组75例,比较2组患者完全缓解（complete remission,CR）率、中枢神经系统白血病（central nervous system leukemia,CNSL）发生率、中位无复发生存（relapse free survival,RFS）时间、中位总生存（overall survival,OS）时间及门冬酰胺酶相关副作用。结果 PEG-Asp组与L-Asp组患者诱导治疗CR率分别为93.18%和93.33%,中位RFS时间分别为306 d和218 d,中位OS时间分别为422 d和495 d,以上指标2组间比较差异均无统计学意义（P〉0.05）;PEG-Asp组后续发生CNSL比例（11.36%）显著低于L-Asp组（29.33%）（χ2=5.11,P=0.024）。不良反应方面,PEG-Asp组患者凝血功能障碍持续时间[（9.13±5.22）d]较L-Asp组[（7.02±4.02）d]延长（t=2.12,P=0.037）。PEGAsp组粒细胞缺乏持续时间长于L-Asp组[（19.26±9.41）vs（11.89±8.35）d,t=4.19,P〈0.01],PEG-Asp组重度感染（Ⅳ~Ⅴ级）发生率为26.83%,高于L-Asp组（5.71%）（χ2=9.86,P=0.002）,但2组出血事件发生率、感染相关死亡率差异无统计学意义（P〉0.05）。结论采用PEG-Asp治疗成人ALL的CR率及远期疗效与L-Asp相似,但后续CNSL的发生率低于L-Asp。PEG-Asp治疗后凝血功能障碍持续时间及粒细胞缺乏持续时间较L-Asp长、重度感染发生率也较L-Asp高,但不增加出血事件发生率和感染相关死亡率。PEG-Asp可作为成人ALL一线治疗的选择。
Objective To evaluate the efficacy and safety of L-asparaginase（ L-Asp） and polyethylene glycol conjugated asparaginase（ PEG-Asp） in VDLP regimen（ vincristine,daunorubicin,Lasparaginase or PEG-asparaginase,prednisone） for induction treatment for adult acute lymphoblastic leukemia（ ALL）. Methods Clinical data of 121 patients with newly diagnosed adult ALL admitted in our department from January 2008 to March 2015 were collected and retrospectively analyzed. They were all treated with VDLP induction regimen,and 46 of them were in the PEG-Asp group and 75 in L-Asp group. Their complete remission（ CR） rate,incidence of central nervous system leukemia（ CNSL）,median relapse free survival（ RFS） time,median overall survival（ OS） time and asparaginase related side effects were compared between the 2 asparaginase groups. Results There were no significant differences between the PEG-Asp group and the L-Asp group in CR rate（ 93. 18% vs 93. 33%）,median RFS（ 306 vs 218 d） and median OS（ 422 vs495 d,P 〉 0. 05）,but the incidence of CNSL was obviously lower in the former than the latter group（ 11. 36% vs 29. 33%,Chi square = 5. 11,P = 0. 024）. In term of the side effects,there were prolonged durations of coagulation dysfunction（ 9. 13 ± 5. 22 vs 7. 02 ± 4. 02 d,t = 2. 12,P = 0. 037） and agranulocytosis（ 19. 26 ± 9. 41 vs 11. 89 ± 8. 35 d,t = 4. 19,P 〈 0. 01） in the PEG-Asp group than the other group.Meanwhile,the rate of severe infection（ grade Ⅳ～ Ⅴ） was remarkably higher in the PEG-Asp group（ 26. 83% vs 5. 71%,Chi square = 9. 86,P = 0. 002）. But there were no statistical differences in the incidences of bleeding event or infection-related mortality（ P 〉 0. 05）. Conclusion Though PEG-Asp has similar CR rate and long-term efficacy as L-Asp in the VDLP regimen for adult ALL,it causes lower incidence of CNSL,and longer durations of agranulocytosis and coagulation dysfunction and higher rate of severe infection. However,it doesn’t lead to higher inc
出处
《第三军医大学学报》
CAS
CSCD
北大核心
2016年第7期737-742,共6页
Journal of Third Military Medical University
基金
国家自然科学基金青年科学基金(81400104)~~
关键词
急性淋巴细胞白血病
培门冬酶
左旋门冬酰胺酶
治疗效果
安全性
acute lymphoblastic leukemia
polyethylene glycol conjugated asparaginase
L-asparaginase
efficacy
safety
