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目的:回顾性分析氟达拉滨(Flu)为主的方案与替尼泊苷+米托蒽醌(MIT)的方案对难治性复发成人急性淋巴细胞白血病(ALL)的疗效及毒副作用。方法:应用替尼泊苷(100mg/d,5~7d)+MIT(10mg/d,2d)的方案和Flu为主的方案[Flu30mg/(m2·d),3~5d,阿糖胞苷(Ara-c)1~2g/(m2·d),5d;及Flu(50mg/d,5d),Ara-c(200mg/d,5d),MIT(4mg/d,4d)]治疗42例难治复发成人ALL。WBC<1.0×109/L时使用粒细胞集落刺激因子(G-CSF)5μg/(kg·d)直至WBC>1.0×109/L。结果:以Flu为主的方案与替尼泊苷+MIT方案(VM)相比:完全缓解(CR)率分别为45%和31.8%,P>0.05;中性粒细胞最低的中位时间均为第6天,WBC<1.0×109中位持续时间分别为10d和7.5d,P>0.05;血小板最低的中位时间分别为第10天和第6.5天,P<0.05;PLT<20.0×109中位持续时间分别为第6天和第10天,P>0.05。Flu组非血液学毒副作用显著少于VM组。结论:两组方案对难治复发ALL均有效,Flu方案毒副作用小,骨髓抑制略轻,缓解率较高,尤其对Ph+ALL疗效显著。
OBJECTIVE: To retrospectively analyze the curative effect and side effects of fludarabine (Flu) -based program and teniposide + mitoxantrone (MIT) on refractory recurrent adult acute lymphoblastic leukemia (ALL). Methods: The main regimen of Fluconazole (Flu30mg / (m2 · d), 3 ~ 5d, Cytarabine (Ara-c) at 1 ~ 2g / (m2 · d), 5d; and Flu (50mg / d, 5d) and Ara-c (200mg / d at 5d) and MIT (4mg / d, 4d) Refractory relapse adult ALL. 5μg / (kg · d) of granulocyte colony-stimulating factor (G-CSF) was used until WBC> 1.0 × 109 / L for WBC <1.0 × 109 / L. RESULTS: Flu-prednisone-based regimen compared with teniposide + MIT regimen: the complete remission (CR) rates were 45% and 31.8%, respectively, P> 0.05; the lowest median neutrophil time On day 6, the median duration of WBC <1.0 × 109 was 10 days and 7.5 days, respectively, P> 0.05; the lowest median platelet count was day 10 and day 6.5, P <0.05; PLT <20.0 × 109 The median duration was 6 days and 10 days respectively, P> 0.05. Flu group had significantly fewer non-hematologic side effects than VM group. Conclusion: The two regimens are effective in refractory relapsed ALL. The Flu regimen has small side effects, slightly mild bone marrow suppression and high remission rate, especially for Ph + ALL.