氟达拉滨耐药的慢性淋巴细胞白血病治疗进展.pdfVIP

· 2492 · M0DERN 0NC0L0GY．Dec．2010．VOI．18．NO．12 氟达拉滨耐药的慢性淋巴细胞 白血病治疗进展 王学文 TherapeuticadvancesofFludarabine--refractorychroniclymphocyticleukemia WANG Xue—wen DepartmentofHematology，NanjingGeneralHospitalofNanjingMilitaryCommand，Nanjing210002，China． A【bstract】Althoughinrecentyearschemoimmunotherapeuticcombinationssuchasfludarabine，cyclophosphamide， andrituximabhaveinduCedresponseratesof95％ inpreviouslyuntreatedpatientsandincreasedtheratesoffailure— freesurviva1．Cl1remainsincurableformanypatientsbecauseofalackofdiseaseresponseorthedevelopmentofre· fractorinesstofludarabine．Salvagetherapeuticstrategiesincludealemtuzumab—containingregimens，targetedagents andallogeneicstem celltransplantation．Single—agentalemtuzumba inducesresponseinupto40％ ofpatientswith fludarabine—refractoryCLL，butresponsesraenotdurba le，andthemediansurvivalisapproximately1to2years． Alemtuzumabisalsocombinedwithfludarbaine，cyclophosphamide，and／orrituximba ，andotheragentssuchasle- nalidomideandflavopiridol，aswellastargetedagents，andusedinfludarbaine—refractoryCLL．Inconclusion，che— moimmunotherapyregimensthatincludealemtuzumba and／orrituximba and allogeneicstem celltransplantationim · provetheprognosisofthisdisease，butthereisaneedfornovel，moreeffectivetherapies． 【Keywords】chroniclymphocyticleukemia；fludarbainerefractory；alemtuzumba；rituximab；Lenalidomide Modem Oncology2010，18(12)：2492—2497 【指示性摘要】对嘌呤类药物发生耐药为慢性淋巴细胞白血病(CLL)患者预后差的特征。虽然近年来免疫化 疗联合应用如氟达拉滨 (Fludarabine，Flu)、环磷酰胺 (CTX)和利妥昔单抗 (rituximba)已导致初治患者反应率 达95％和无失败生存率增加，但因为缺乏治疗反应和对Flu耐药许多慢淋患者仍不能治愈。补救治疗的策略 包括含阿来组单抗 (alemtuzumba)的方案、靶向药物和异基因造血干细胞移植 (allo—SCT)。单药 alemtuzumab 治疗 Flu耐药的CLL患者反应率高达40％，但反应并不持久，中数生存期约 1—2年。耐Flu—CLL患者亦可 采用alemtuzumab与Flu、CTX和／或利妥昔单抗，或其他药物如雷利度胺 (1enalidomide)、flavopiridol和靶向药