| Objective: To observe the efficacy,safety and long-term effects of etoposide,ifosfamide and mitoxantrone in the treatment of Ph-acute lymphoblastic leukemia(ALL).Methods: Eight cases of relapsed and refractory Ph-ALL cases admitted to the Affiliated Hospital of China Medical University from September 2011 to July 2015 were collected,including 5 males and 3 females,aged 21 to 43 years,with an average of 31 years old;6cases of T-ALL,1 case of B-ALL,and 1 case of acute mixed cell leukemia M/T;1-2courses of etoposide(E)100 mg/(1)in 8 patients with relapsed and refractory acute lymphoblastic leukemia(ALL)M2.d)Continuous infusion for 5 d,ifosfamide(I)1.5g/(m2 d)for 5 d(maximum dose not exceeding 2 g/d),Mituone(M)8 mg/(m2.d),continuous intravenous infusion for 3 days,observation and recording of adverse reactions during chemotherapy,2 weeks after the end of treatment,bone marrow examination;Result:(1)CR was obtained in 5 cases(62.5%)of 8 relapsed and refractory Ph-ALL cases,PR was obtained in 2 cases(25%),the effective rate was 87.5%,and NR was 1case(12.5%);5 CR patients Among them,MRD was not detected in 1 case,MRD was detected in 10-3 levels after treatment,and the remaining 3 cases were in 10-2 level.(2)The median survival time of all patients was 23.4(9.6-64)months,and all patients died until the follow-up deadline.Patient 1 had partial relief after 1 course of treatment with EIM regimen.He did not continue to apply this protocol for his own reasons.After receiving a complete remission of MEA 1,the patient received an allo-HSCT after complete remission,and died(64 months)by the date of follow-up;Patient 5 received partial remission after 2 cycles of EIM,and relapsed after disease(21.5 months);Patient7 EIM protocol CR was obtained after 1 course of chemotherapy,and recurrence of disease died after 1 month(9.6 months);patient 8 did not receive remission after 1 course of EIM regimen chemotherapy,and did not receive CR after other chemotherapy regimens,and died after treatment(10.6 months).The remaining 4 patients achieved CR after 1-2 cycles of EIM regimen chemotherapy,all CR patients received allo-HSCT;at the final follow-up,3 patients died of leukemia relapse(25.3 months,31.6 months,and32 months,respectively).One case died of septic shock(13.5 months),2 year survival rate50%;(3)All patients had no significant hepatic or renal impairment,no patient stopped treatment due to toxicity,and no patient died of infection or bleeding.All patients had neutrophil and thrombocytopenia,and 1 patient started chemotherapy on the 3rd day.There was agranulocytosis,1 patient did not have agranulocytosis;the remaining 6patients had a median duration of neutropenia of 10(4-15)days,and 7 patients had platelet count <20 × 10^9/L,duration was 2(1-12)days.The lowest neutrophil count was0×10^9/L.The infection rate was high during this period,and was controlled after antibiotic and antifungal treatment.After using leukocyte-removing drugs,the hemogram basically returned to normal after about 2 weeks,and the platelet count was lowest.At3×10^9/L,there was bleeding in the skin and mucous membranes.After transfusion of platelet and platelet-strengthening drugs,the patient returned to normal after 1 to 2 weeks,with no fatal bleeding tendency.Conclusion: EIM regimen is effective and feasible for the treatment of relapsed and refractory Ph-acute lymphoblastic leukemia.The recent remission rate is high,but it can not improve the long-term curative effect.Due to the small sample size,more cases need to be clinically confirmed. |
PDF Full Text Request