氨磷汀对软组织肉瘤化疗后骨髓抑制的保护作用

目的: 观察氨磷汀对软组织肉瘤化疗后骨髓抑制的保护作用及其安全性。方法: 将病理学确诊为软组织肉瘤的39例患者随机分为氨磷汀组和对照组,均给予AI方案化疗(阿霉素30mg·m^-2,iv,d1~2+异环磷酰胺3g·m^-2,iv,d1~3,每21天为一周期),氨磷汀组另于化疗前30min给予氨磷汀注射(500mg·m^-2,d1~3),分别观察2组的骨髓抑制发生率及恢复时间,同时记录氨磷汀的毒副作用(低血压、胃肠道反应、低血钙症、过敏等)。结果: 氨磷汀组(n=19)患者共接受113次化疗,对照组(n=20)患者共接受118次化疗,其中氨磷汀组和对照组Ⅳ度粒细胞减少分别为8.8%和18.6%(P<0.05),Ⅳ度血小板减少发生率分别为0.9%和5.9%(P<0.05);但Ⅲ度粒细胞减少及Ⅲ度血小板减少发生率均无统计学差异(P>0.05),氨磷汀组和对照组平均每次化疗输注血小板分别(0.01±0.01)和(0.06±0.04)人份(P<0.05),而输注红细胞的量则无统计学差异(P>0.05)。Ⅳ度白细胞减少恢复时间分别为(3.23±0.18)d和(5.11±0.23)d(P<0.001)。2组Ⅲ度呕吐发生率分别为26.5%和15.3%(P<0.05),一过性血压降低的发生率分别为25.7%和0.8%(P<0.001)。氨磷汀组其余不良反应与对照组无明显差异(P>0.05)。结论: 氨磷汀对软组织肉瘤AI方案化疗后出现的Ⅳ度粒细胞减少和血小板减少有保护作用,且未见明显毒副反应。

Myeloprotection of amifostine after chemotherapy against soft tissue sarcomas

OBJECTIVE To evaluate myeloprotectin effects of amifostine after chemotherapy against soft tissue sarcomas and its adverse effects. METHODS Thirty nine patients were divided into two groups randomly. All patients received AI chemotherapy composed of doxorubicin (30 mg·m^-2 for the first 2 days) and ifosfamide (3 g·m^-2 for the first 3 days),every 21 days was a cycle.Patients in treatment group had amifostine (500 mg·m^-2) injected 30 minutes before chemotherapy drugs for the first 3 days.Chemotherapy-induced myelosuppression,recovery time and side effects of amifostine,such as hypotension,gastrointestinal reactions,hypocalcemia,hypersusceptibility reactions,were monitored. RESULTS Nineteen patients received 113 cycles of chemotherapy in treatment group and 20 patients received 118 cycles of chemotherapy in control group.Incidences of grade 4 neutropenia and grade 4 thrombocytopenia were lower in treatment group (8.8% vs.18.6% and 0.9% vs.5.9%,respectively,P<0.05).Volumes of myelosupression-induced red cell transfusions and platelet transfusions in treatment group and control group were (0.16±0.10)U vs.(0.20±0.11)U (P>0.05) and (0.01±0.01)U vs.(0.06±0.04)U,respectively (P<0.05).Incidences of grade 3 leukocytopenia and grade 3 thrombocytopenia in treatment group and control group were 18.6% vs.23.7% and 7.1% vs.9.3%,respectively (P>0.05).Recovery time of grade 4 leukocytopenia in treatment group was shorter than control group (3.23±0.18 days vs.5.11±0.23 days,P<0.01).Incidence of grade 3 vomiting in treatment group was increased compared to control group (26.5% vs.15.3%,P<0.05).After injection of amifostine,25.7% patients had transient hypotension in treatment group and 0.8% patients in control group (P<0.05).Statistical analysis showed no difference in other adverse effects. CONCLUSION Amifostine has significant protecting effects against grade 4 neutropenia and grade 4 thrombocytopenia caused by chemotherapy against soft tissue sarcomas.Side effects of amifostine,such as vomiting and transient hypotension,can be tolerated and controlled.