奈拉滨治疗2例成人复发/难治性T淋巴细胞白血病的疗效并文献复习

目的观察奈拉滨治疗成人复发/难治性T淋巴细胞白血病的疗效及不良反应。方法奈拉滨1 500 mg/(m2.d)静滴2 h(第1、3、5天),21 d为1个疗程。1例复发性T-ALL给予2个疗程,1例难治性T-ALL给予1个疗程。结果 1例复发T-ALL在第1个疗程后获完全缓解伴不完全血象恢复(CRi),继续应用奈拉滨1个疗程后获CR。但4个月后疾病再次复发。8个月后死于急性心肌梗塞。另1例难治性T-ALL应用1个疗程后无治疗反应,停用奈拉滨,应用其他联合化疗后获CR,已行异基因造血干细胞移植,病情稳定。2例患者均出现Ⅲ～Ⅳ级血液学不良反应,Ⅰ～Ⅱ级神经系统毒性,Ⅰ级消化道反应,1例出现轻度肝功异常。无奈拉滨治疗相关死亡。结论奈拉滨用于治疗复发/难治性T淋巴细胞白血病,疗效尚可,不良反应可以耐受,可作为T-ALL治疗的一个新选择。

Curative effect of nelarabine in 2 cases of adult relapsed/refractory T-cell acute lymphoblastic leukemia and review of the literatures

Objective To assess the efficacy and safety of nelarabine treatment for adult relapsed/refractory T-cell acute lymphoblastic leukemia.Methods Nelarabine was administered at a dose of 1 500 mg/(m2 · d)for 2 h iv drop on the 1st,3rd and 5th day,cycles were repeated every 21 d.One patient with relapsed T-ALL accepted 2 cycles.Another patient with refractory T-ALL was given only 1 cycle.Results The relapsed T-ALL patient obtained CRi after one cycle,and achieved CR after two cycles.He relapsed after 4 months again,and died of acute myocardial infarction after 8 months.The refractory T-ALL patient was non-responding.He had received allogeneic stem-cell transplantation after CR1 by other chemotherapy regimen.Conclusion Nelarabine is active as a single agent in adult relapsed T-ALL with acceptable toxicity.No toxicity-related death on treatment is observed.Nelarabine may provide an alternative chemotherapeutic approach for T-ALL patients.