吡柔比星治疗难治及复发性恶性血液病的临床效果和不良反应

摘要

Objective To observe the clinical effect and adverse reactions of pirarubicin in treatment of refractory and recurrent malignant hematopathy.Methods Clinical records of 56 patients with refractory and recurrent malignant hematopathy were retrospectively analyzed from February 2013 to February 2017 in the Second Hospital of Jiaxing;24 cases were acute nonlymphocytic leukemia(ANLL) [including 4 cases of chronic myelocytic leukemia(CML) blast crisis];12 cases were acute lymphoblastic leukemia(ALL);14 cases were non-Hodgkin lymphoma(NHL);6 cases were multiple myeloma (MM).All patients were treated with pirarubicin-based combined chemotherapy.Clinical efficacy of chemotherapy,occurrences of bone marrow suppression and other adverse reactions were observed.Results The overall remission rate was 75.0％ (42/56);25 patients(44.6％) had complete remission;17 patients(30.4％) had partial remission;remission rate of ANLL was 75.0％ (15/20);remission rate of CML blast crisis was 75.0％ (3/4);remission rate of ALL was 83.3％ (10/12);remission rate of NHL was 71.4％ (10/14);remission rate of MM was 66.7％ (4/6).The incidence of bone marrow suppression was 87.5％ (49/56);19 patients(33.9％) had infection and 12 patients(21.4％) had hemorrhage caused by bone marrow suppression;other adverse reactions were tolerable.Conclusion Pirarubicin-based combined chemotherapy has good curative effect and mild adverse effect on refractory and recurrent hematopathy.%目的 观察以吡柔比星为主的联合化疗方案治疗难治及复发性恶性血液病的临床效果和不良反应.方法 回顾性分析2013年2月至2017年2月浙江省嘉兴市第二医院收治的56例难治及复发性恶性血液病患者的病历资料.其中急性非淋巴细胞白血病(ANLL) 24例[包括慢性粒细胞白血病(CML)急变期4例],急性淋巴细胞白血病(ALL) 12例,非霍奇金淋巴瘤(NHL) 14例,多发性骨髓瘤(MM)6例.均采用以吡柔比星为主的联合化疗方案进行治疗.观察患者治疗前后的临床症状、体征改善情况,以及用药后的临床疗效和骨髓抑制等不良反应.结果 56例患者的总缓解率为75.0％ (42/56),其中25例(44.6％)完全缓解,17例(30.4％)部分缓解;其中ANLL缓解率为75.0％ (15/20),CML急变期缓解率为75.0％ (3/4),ALL缓解率为83.3％ (10/12),NHL缓解率为71.4％ (10/14),MM缓解率为66.7％(4/6).主要的不良反应是骨髓抑制,有49例(87.5％)患者化疗后出现骨髓抑制.因骨髓抑制引起感染、出血分别为19例(33.9％)、12例(21.4％),其他不良反应均可耐受.结论 以吡柔比星为主的联合化疗方案对于难治及复发性恶性血液病有较好的临床疗效,且不良反应轻微.