氟达拉滨和环磷酰胺联合利妥昔单抗治疗慢性淋巴细胞白血病疗效分析

目的 探讨氟达拉滨和环磷酰胺联合利妥昔单抗(FCR方案)治疗慢性淋巴细胞白血病(CLL)的效果.方法 采用FCR方案治疗21例CLL患者,其中10例为初治患者,11例为复治患者.FCR方案为氟达拉滨25 mg/m2,第2～4天,静脉滴注;环磷酰胺250 mg/m2,第2～4天,静脉滴注;利妥昔单抗375 mg/m2,第1天,静脉滴注.每28 d为1个疗程.采用多参数流式细胞术(FCM)检测微量残留病(MRD).同时对治疗前临床特点与完全缓解(CR)率行相关性分析.结果 11例(52.4%)患者获得CR,7例(33.3%)获得部分缓解,总有效率为85.7%;中位随访时间19(7～73)个月,总生存率为86.0%,无进展生存率为72.0%.单变量分析表明治疗前Binet分期为A+B、免疫球蛋白重链可变区基因有突变或ZAP-70阳性细胞率≤20%与高CR率相关;6例患者化疗后MRD低于1%.FCR方案的不良反应主要表现为骨髓抑制和胃肠道反应.结论 FCR方案对CLL的治疗有确切疗效.

Abstract：

Objective To evaluate the efficacy of combination chemoimmunotherapy of fludarabine,cyclophosphamide and rituximab (FCR) in chronic lymphocytic leukemia (CLL). Methods Twenty-one patients with CLL were treated with FCR regimen which consisted of fludarabine (25 mg/m2, days 2 to 4),cyclophosphamide (250 mg/m2, days 2 to 4) and rituximab ( 375 mg/m2, day 1 ) in a course of 28 days.The minimal residual disease (MRD) was determined by multiparameter flow cytometry. The correlation between the pretreatment characteristics and complete remission (CR) rate was analyzed. Results Eleven patients (52.4%) achieved CR, 7 (33.3%) achieved partial remission (PR) with a overall response (OR)rate of 85.7%. With a median follow-up time of 19 (7 -73 ) months, the overall survival (OS) was 86.0%,and the progression-free survival (PFS) was 72.0%. Pretreatment parameters independently associated with higher CR rates were Binet stage A + B, IgVH mutated and ZAP-70 less than 20%. MRD was less than 1% in 6 patients. The most common toxicities were myelosuppression and gastrointestinal reaction. Conclusion FCR is an effective regimen for CLL patients.

Efficacy of combination chemoimmunotherapy of fludarabine, cyclophosphamide and rituximab for chronic lymphocytic leukemia

Objective To evaluate the efficacy of combination chemoimmunotherapy of fludarabine,cyclophosphamide and rituximab (FCR) in chronic lymphocytic leukemia (CLL). Methods Twenty-one patients with CLL were treated with FCR regimen which consisted of fludarabine (25 mg/m2, days 2 to 4),cyclophosphamide (250 mg/m2, days 2 to 4) and rituximab ( 375 mg/m2, day 1 ) in a course of 28 days.The minimal residual disease (MRD) was determined by multiparameter flow cytometry. The correlation between the pretreatment characteristics and complete remission (CR) rate was analyzed. Results Eleven patients (52.4%) achieved CR, 7 (33.3%) achieved partial remission (PR) with a overall response (OR)rate of 85.7%. With a median follow-up time of 19 (7 -73 ) months, the overall survival (OS) was 86.0%,and the progression-free survival (PFS) was 72.0%. Pretreatment parameters independently associated with higher CR rates were Binet stage A + B, IgVH mutated and ZAP-70 less than 20%. MRD was less than 1% in 6 patients. The most common toxicities were myelosuppression and gastrointestinal reaction. Conclusion FCR is an effective regimen for CLL patients.