PDF(Pubmed)
Abstract：
BACKGROUND: Hyper-CVAD (hyperfractionated cyclophosphamide, vincristine, doxorubicin and dexamethasone) has become a popular regimen for adults with acute lymphoblastic leukemia (ALL). We assessed the efficacy and tolerability of hyper-CVAD in the treatment of adult ALL.
METHODS: We retrospectively reviewed ALL patients aged 18 or above receiving the hyper-CVAD regimen. We assessed complete remission rate and overall survival, as well as hepatitis B carrier rate and hepatitis flare due to hepatitis B virus (HBV) reactivation.
RESULTS: Fifty-two patients were treated with the hyper-CVAD regimen. The median age at diagnosis was 42 years; 27% of patients were Philadelphia (Ph) chromosome positive. The complete remission (CR) rate was 90.4% after the first cycle of chemotherapy. The induction mortality rate was 1.9%. Three patients required two cycles of hyper-CVAD to achieve CR. The median overall survival was 39.6 months and the 5-year overall survival was 50%. Age over 30 years and white blood cell count of more than 30 × 109/l were found to be prognostic for poor overall survival in multivariate analysis. The hepatitis B carrier rate was 17% in our cohort, and the rate of hepatitis flare due to HBV reactivation was 11% in patients with current infection.
CONCLUSIONS: Hyper-CVAD is feasible and tolerable with a good CR rate in the treatment of adult ALL patients. It is an option for the treatment of ALL. Antiviral prophylaxis should be considered in ALL patients with HBV infection to reduce the risk of HBV reactivation.
METHODS: We retrospectively reviewed ALL patients aged 18 or above receiving the hyper-CVAD regimen. We assessed complete remission rate and overall survival, as well as hepatitis B carrier rate and hepatitis flare due to hepatitis B virus (HBV) reactivation.
RESULTS: Fifty-two patients were treated with the hyper-CVAD regimen. The median age at diagnosis was 42 years; 27% of patients were Philadelphia (Ph) chromosome positive. The complete remission (CR) rate was 90.4% after the first cycle of chemotherapy. The induction mortality rate was 1.9%. Three patients required two cycles of hyper-CVAD to achieve CR. The median overall survival was 39.6 months and the 5-year overall survival was 50%. Age over 30 years and white blood cell count of more than 30 × 109/l were found to be prognostic for poor overall survival in multivariate analysis. The hepatitis B carrier rate was 17% in our cohort, and the rate of hepatitis flare due to HBV reactivation was 11% in patients with current infection.
CONCLUSIONS: Hyper-CVAD is feasible and tolerable with a good CR rate in the treatment of adult ALL patients. It is an option for the treatment of ALL. Antiviral prophylaxis should be considered in ALL patients with HBV infection to reduce the risk of HBV reactivation.
摘要：
背景：Hyper-CVAD（超分馏环磷酰胺，长春新碱,多柔比星和地塞米松）已成为成人急性淋巴细胞白血病（ALL）的流行方案。我们评估了hyper-CVAD治疗成人ALL的疗效和耐受性。
方法：我们回顾性分析了接受超CVAD方案的所有18岁或以上患者。我们评估了完全缓解率和总生存率，以及乙型肝炎病毒（HBV）再激活导致的乙型肝炎携带者率和肝炎发作。
结果：52例患者接受超CVAD方案治疗。诊断时的中位年龄为42岁；27％的患者为费城（Ph）染色体阳性。第一周期化疗后完全缓解(CR)率为90.4%。诱导死亡率为1.9%。三名患者需要两个周期的hyper-CVAD来实现CR。中位总生存期为39.6个月，5年总生存期为50%。在多变量分析中，发现年龄超过30岁和白细胞计数超过30×109/l是总体生存率较差的预后。在我们的队列中，乙型肝炎携带者率为17％，在当前感染的患者中，由于HBV再激活引起的肝炎发作率为11％。
结论：Hyper-CVAD治疗成人ALL患者是可行的和可耐受的，CR率良好。这是治疗所有人的一种选择。所有HBV感染患者应考虑抗病毒预防，以降低HBV再激活的风险。
方法：我们回顾性分析了接受超CVAD方案的所有18岁或以上患者。我们评估了完全缓解率和总生存率，以及乙型肝炎病毒（HBV）再激活导致的乙型肝炎携带者率和肝炎发作。
结果：52例患者接受超CVAD方案治疗。诊断时的中位年龄为42岁；27％的患者为费城（Ph）染色体阳性。第一周期化疗后完全缓解(CR)率为90.4%。诱导死亡率为1.9%。三名患者需要两个周期的hyper-CVAD来实现CR。中位总生存期为39.6个月，5年总生存期为50%。在多变量分析中，发现年龄超过30岁和白细胞计数超过30×109/l是总体生存率较差的预后。在我们的队列中，乙型肝炎携带者率为17％，在当前感染的患者中，由于HBV再激活引起的肝炎发作率为11％。
结论：Hyper-CVAD治疗成人ALL患者是可行的和可耐受的，CR率良好。这是治疗所有人的一种选择。所有HBV感染患者应考虑抗病毒预防，以降低HBV再激活的风险。
