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硼替佐米联合化疗治疗4例复发难治性急性淋巴细胞白血病
作者:陶善东1  宋立孝1  陈月1  丁邦和1  周立涛1  何正梅1  王春玲1  李玉峰1  于亮1 2 
单位:1. 南京医科大学附属淮安第一医院 血液科, 江苏 淮安 223300;
2. 南京医科大学 血液病重点实验室, 江苏 南京 210029
关键词:硼替佐米 联合化疗 复发难治性急性淋巴细胞白血病 
分类号:R733.71;R453
出版年·卷·期(页码):2018·37·第二期(215-219)
摘要:

目的:观察硼替佐米联合化疗方案治疗复发难治性急性淋巴细胞白血病(ALL)的疗效。方法:采用硼替佐米联合DOLP (硼替佐米1.3 mg·m-2第1、4、8、11天,柔红霉素60 mg·m-2第1至第3天,长春新碱2 mg第1、8、15、22天,门冬酰胺酶2 000 IU·m-2第2、8、15、21天,地塞米松10 mg第1至第14天)方案治疗复发难治性ALL 3例,硼替佐米联合COMEP (环磷酰胺750 mg·m-2第1、3天,米托蒽醌4 mg第1至第4天,地塞米松10 mg第1至第14天,依托泊苷0.1 g第1至4天,长春新碱2 mg第1、8、15、22天)方案治疗复发难治性ALL 1例,并通过比较化疗前后的患者血常规、骨髓细胞形态、免疫分型、细胞遗传学及NFκB表达与活性评估疗效。结果:3例硼替佐米联合DOLP方案化疗的患者中2例1个疗程完全缓解,1例1个疗程部分缓解,1例硼替佐米联合COMEP方案化疗的患者未缓解。结论:硼替佐米联合化疗及靶向治疗药物为复发难治性ALL的治疗提供了新策略。

Objective:To observe the effect of bortezomib combined with chemotherapy in patients with relapsed and refractory acute lymphoblastic leukemia(ALL). Methods:Three cases of relapsed and refractory ALL were treated with bortezomib(1.3 mg·m-2 dose, day 1,4,8,11) in combination with DOLP(doxorubicin 60 mg·m-2 dose, day 1 to 3, vincristine 2 mg dose, day 1,8,15,22, L-asparaginase 2 000 IU·m-2 dose, day 2,8,15,21, dexamethasone 10 mg dose, day 1 to 14), One case of relapsed and refractory ALL was treated with bortezomib (1.3 mg·m-2 dose, day 1,4,8,11) in combination with COMEP (cyclophosphamide 750 mg·m-2 dose, day 1,3, mitoxantrone 4 mg dose, day 1 to 4, dexamethasone 10 mg dose, day 1 to 14, etoposide 0.1 g dose, day 1 to 4, vincristine 2 mg dose, day 1,8,15,22). The curative effects by peripheral blood, bone marrow cell morphology, immunophenotyping, cytogenetics, and detected NFκB expression level before and after chemotherapy were evaluated. Results:2 cases of 3 cases who received bortezomib combined with DOLP regimen had complete remission with a course of chemotherapy, 1 case had partial remission, 1 case who received bortezomib combined with COMEP regimen did not have response with one course of chemotherapy. Conclusion:Bortezomib combined with chemotherapy and targeted therapy drugs can provide new strategies for the treatment of relapsed and refractory ALL.

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