氟哒拉滨联合抗CD单克隆抗体及氨磷汀治疗高龄慢性淋巴细胞白血病.docVIP

氟哒拉滨联合抗CD单克隆抗体及氨磷汀治疗高龄慢性淋巴细胞白血病 　 作者：刘洋，朱宏丽，卢学春，李素霞 【摘要】 慢性淋巴细胞白血病（CLL）是一种恶性淋巴细胞增生性疾病，老年人多发。目前CLL治疗的主要问题是： ①治疗完全缓解率低；②CLL伴随免疫系统功能紊乱和治疗药物的骨髓抑制、感染等副作用，高龄患者难以耐受。本研究报告我科成功治疗1例74岁高龄B细胞性慢性淋巴细胞白血病患者。在治疗中采用核苷酸还原酶抑制剂即氟达拉滨，联合抗CD20单克隆抗体方案,按标准治疗剂量给药，并根据患者个体情况调整给药时间,运用泛细胞保护剂氨磷汀进行辅助治疗。结果表明: 1个疗程治疗后患者达到完全缓解，外周血的细胞计数和分类恢复正常；继续应用氨磷汀辅助治疗20天，患者贫血得到纠正，血红蛋白量稳定在120 g/L以上，化疗药物的副作用和并发症均得到了有效的控制。结论： 老年CLL患者化疗过程中，采用氟哒拉滨联合抗CD20单克隆抗体方案，按标准剂量给药，同时根据患者自身情况调整给药次序和给药时间，体现个性化治疗，获得满意疗效；氨磷汀可以有效减轻或克服CLL伴随的免疫系统功能紊乱，以及氟哒拉滨、抗CD20单克隆抗体引起的骨髓抑制、感染、发热等副反应。 【关键词】 慢性淋巴细胞白血病 Curative Efficacy of Fludarabine Combined with Rituximab and Amifostine on Aged Patient with BChronic Lymphocytic Leukemia Abstract Chronic lymphocytic leukemia (CLL) is characterized by a progressive accumulation of lymphocytes, which occurs predominantly in elderly patients. As present one of the major problems in the treatment of CLL is low complete remission rate, others are complication and toxicity of drugs, such as myelosuppression, infections and disorder of immunosystem function, especially in elderly patients. This study reported that a 74yearold male patient with BCLL effectively and safely was treated with fludarabine (nucleatide reductase inhibitor), rituximab (antiCD20 monoclonal antibody) and amifostine. The patient was given fludarabine and rituximab in standard dose, but the time of drug given is different from comventional treatment, it was adjusted according to the patient status. The results showed that no chill, fever and infection occured during treatment. Furthermore, blood cell count and hemoglobin level recovered to mormal after the end of treatment. In conclusion, the individualized protocol of fludarabine combined with rituximab and amifostine showed the safety and effectiveness for treatment of aged patient with CLL. Amifostine is drug known as chemoprotectants, can alleviate or eliminate the immunological disorder from CLL and the adverse effects from chemotherapy, such as myelosuppression, infection, fe