吡喃阿霉素在儿童恶性肿瘤治疗中的远期疗效与心脏毒性观察

目的：探讨吡喃阿霉素（4—6-tetrahydropy-ranyl—adriamycin，THP）治疗儿童恶性肿瘤的远期疗效，以及患儿对THP的耐受性。方法：在儿童急性自血病、晚期淋巴瘤和其他晚期恶性肿瘤的长期化疗中，以THP取代联合化疗方案中的柔红霉素（DNR）和阿霉素（ADR）。统计远期疗效，观察THP所致的心脏毒性发生率和其他并发症。结果：总计治疗92例儿童恶性肿瘤，按Kaplan-Meier生存率曲线法统计急性淋巴细胞白血病（ALL）、非霍奇金淋巴瘤（NHL）和急性髓系白血病（AML）的6年以上无病生存率（disease-freesurvival，DFS）分别76．43％、78．58％和46．47％。其他晚期实体肿瘤的CR和PR率分别为62．5％和25．0％。本组仅3例出现THP所致心脏损害（心律紊乱和传导阻滞），其中2例改用CTX和VP16后，最终获得长期无病生存。治疗中THP最大累积剂量为600mg／m^2。结论：以THP取代ADR和DNR，在保证远期疗效的基础上，可明显降低心脏毒性反应的发生率。

The long-term outcomes and the chemotherapy-related cardiac toxicity of pirarubicin in the treatment of childhood ma lignancies

Objective:To study the long-term outcomes of pirarubicin(THP)in the treatment of childhood malignancies and the tolerance of the patients to THP.Methods:THP was used to replace daunorubiein(DNR)and adriamycin(ADR)and DNR in the protocols for the long-term chemotherapy for childhood acute leukemia,advanced Non-Hodgkin's Lymphoma(NHL)and other advanced solid tumors.The long-term efficacy,the occurrence of cardiac toxicity,and other complications were observed. Restdts:Kaplan-Meier survival analysis showed that there are total 92 cases with childhood malignances,the Disease Free Surviv- al(DFS)rate of more than 6 years for acute lymphoblastic leukemia(ALL),advanced NHL,and acute myeloid leukemia (AML)are 76.43 %,78.58%.and 46.47%,respectively.The complete response(CR)and partial response(PR)rate of other advanced solid malignant tumor were 62.5% and 25.0%,respectively.The THP-induced cardiac toxicity(cardiac arrhythmias and conduction block)occurred in only 3 cases.Two of 3 cases achieved long-term disease-free survival after replacing CTX or VP16 with THP CTX or VP16 in the protocols.There was no evidence of THP-induced cardiac toxicity in other 89 eases.The maximal cumulative dose of THP was 600 mg/m~2.Conclusion:Replacing ADR and DNR with THP in the protocols achieves higher DFS and reduces the cardiac toxicity on the basis of assuring the long-term outcomes.