在儿科骨髓瘤中减强多克索鲁比剂量,更少更好吗?
Hadeel Halalsheh1,2, Ramiz Abu-Hijlih3, Taleb Ismael1
1Department of Pediatrics, King Hussein Cancer Center, Amman, Jordan.
South Asian journal of cancer
|December 4, 2023
概括
在骨髓瘤治疗中降低多克索鲁比剂量可能提供足够的疾病控制,心脏毒性降低. 这种方法可能对心力衰竭管理资源有限的发展中国家有益.
科学领域:
- 儿科瘤学 儿科瘤学
- 心血管毒理学心血管毒理学
- 化疗疗方案 化疗方案
背景情况:
- 骨髓瘤治疗指南通常涉及高累积剂量的多克索鲁比辛.
- 对多克索鲁比诱导的心脏毒性的担忧促使对剂量降级进行了调查.
- 2009年实施新的临床实践指南 (CPG),旨在标准化骨髓瘤治疗.
研究的目的:
- 评估小儿骨髓瘤患者减少多克索鲁比辛累积剂量的疗效和安全性.
- 评估多克索鲁比辛剂量减强后的生存率和心脏事件.
- 为了确定修改后的化疗方案是否能够保持足够的疾病控制,同时最大限度地减少心脏毒性.
主要方法:
- 在2009年至2018年期间接受治疗的18岁以下骨髓瘤患者的回顾性队列研究.
- 患者接受了统一的CPG,并减少了375 mg/m2.2的累积多克索鲁比辛剂量.
- 计算了生存率 (无事件生存率和总生存率),并使用了日志等级测试进行比较.
主要成果:
- 79名患者接受了减少剂量的多克索鲁比治疗;中位数随访时间为43.3个月.
- 5年无事件生存率 (EFS) 为50%±5.9%,整体生存率 (OS) 为64%±5.7%.
- 对于非转移性四肢瘤 (n=56),五年EFS为60%±6.9%,OS为70%±6.8%. 化疗反应与更好的EFS和OS相关 (p<0.05). 只有两名患者经历过渡性心脏功能障碍.
结论:
- 减少多克索鲁比的强度可能为儿科骨髓瘤提供足够的疾病控制.
- 减少多克索鲁比辛治疗方案显示可接受的存活率与最小的心脏毒性.
- 这种方法对于资源有限的环境可能是一个可行的选择,考虑到心力衰竭的发病率较低.
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