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Lancet：ABVD方案是早期霍奇金淋巴瘤的标准方法

2015-01-13 MedSci MedSci原创

ABVD霍奇金淋巴瘤
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为减小ABVD（阿霉素、博来霉素、长春花碱、氮烯咪胺）化疗方案的毒性，一些观点认为氮烯咪胺、博来霉素或两者同时可被舍弃且不影响疗效。而一项非盲、随机的国际临床试验表明，无氮烯咪胺或博来霉素的标准ABVD联合化疗效果不佳。该试验纳入1502名一般情况较好的早期霍奇金淋巴瘤患者，对其进行 2个疗程的ABVD或ABV/AV/AVD治疗，并分析了其5年治疗无失败生存率(FFTF)。研究者德国霍奇金研究组及

为减小ABVD（阿霉素、博来霉素、长春花碱、氮烯咪胺）化疗方案的毒性，一些观点认为氮烯咪胺、博来霉素或两者同时可被舍弃且不影响疗效。而一项非盲、随机的国际临床试验表明，无氮烯咪胺或博来霉素的标准ABVD联合化疗效果不佳。

该试验纳入1502名一般情况较好的早期霍奇金淋巴瘤患者，对其进行 2个疗程的ABVD或ABV/AV/AVD治疗，并分析了其5年治疗无失败生存率(FFTF)。研究者德国霍奇金研究组及科隆大学附属医院的Andreas Engert表示：较标准的ABVD 疗法，ABV、AVD 及AV 的5年治疗无失败生存率显著减低。该研究在12月22号在线出版的《柳叶刀》杂志上。

但与28%接受ABV、 26%接受 AVD和 27%接受 AV疗法的患者相比，约1/3接受标准ABVD疗法的患者有至少一级的III/IV级不良事件。研究者表示：尽管如此，各组总生存率间并无差异且不存在一线治疗的毒性反应所引起的死亡。因此他们得出结论 ：“未更改的ABVD化疗方案后加受累区域放疗（IFRT）应继续作为情况较好的早期霍奇金淋巴瘤患者的标准疗法。”

法国Lyon-Sud 医疗中心的Bertrand Coiffier博士对此表示：“ABVD疗法已存在20余年，假如有药物不是必须的，一定早就被描述，因此我并不惊讶于该研究结果。但由于这些药物存在潜在毒性，为尽量避免化疗毒性而阐明这一点确有必要。将来，减少霍奇金淋巴瘤治疗方案毒性的最佳方式将是减小放疗毒性。任何癌症标准治疗的安全性/有效性比率定不能只看3、4年的随访结果，而需更长时间的随访来观察其长期毒性和疗效。”

来自以色列的Eldad J. Dann博士则表示，在安全委员会因治疗失败的高发生率而关闭了AV/ABV的试验组后，氮烯咪胺应作为早期霍奇金淋巴瘤化疗方案的骨干药物。真正的问题在于是否能够在年轻群体中省去化疗。

华盛顿乔治敦大学的Bruce Cheson博士同样对淋巴瘤治疗有丰富的经验：“我不同意该结果的解释，仅看ABVD 和AVD 组，完全缓解率和进展率是相似的，总生存率至少与无博来霉素一样良好。然而AVD方案的毒性尤其中性粒细胞减少非常小。此外，因博来霉素造成的肺死亡是存在的。”他还提到，AVD方案前期用药少且价廉。

Joachim Yahalom博士是纽约Sloan-Kettering纪念癌症中心（MSKCC）淋巴瘤管理团队的联合领导人，他认为：烷化剂如氮烯咪胺显然有助治疗且非常重要。博来霉素的贡献是次要的，且可能因需要更多疗程而增加患病率。此外，其他药物被加入ABV时疗法时，它仍有毒性。在MSKCC，他们对早期情况较好的霍奇金淋巴瘤患者（多为肿块型）使用brentuximab vedotin加入AVD方案化疗后行受累区域放疗，初步结果非常好。

Yahalom博士估计，在将来霍奇金淋巴瘤的很多期治疗中，brentuximab vedotin将取代博来霉素。他表示：“从一种已建立的方案中删除一种组分需要严谨的、统计学上健全的计划和分析，尤其是在设计一个非劣效性试验时。”

原始出处：
Casasnovas O, Coiffier B.Hodgkin's lymphoma: better outcomes with fewer drugs? Lancet. 2014 Dec 19. pii: S0140-6736(14)61701-3

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    2015-10-09 howi

    #Lancet#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1827972, encodeId=b7f5182e9725a, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Oct 09 06:17:00 CST 2015, time=2015-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043682, encodeId=f3c6204368275, content=<a href='/topic/show?id=99ee1e88e3' target=_blank style='color:#2F92EE;'>#ABVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1788, encryptionId=99ee1e88e3, topicName=ABVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c2e485, createdName=yangfl06, createdTime=Tue Mar 24 05:17:00 CST 2015, time=2015-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14290, encodeId=a3dd14290db, content=不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:16:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14291, encodeId=072b1429174, content=不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:16:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14288, encodeId=f589142880d, content=同意楼上的, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:14:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14289, encodeId=aab21428920, content=同意楼上的, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:14:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14278, encodeId=2fb6142e86a, content=接下来应该对比AVD与ABVD方案, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=175.8.224.**, createdTime=Tue Jan 13 22:30:00 CST 2015, time=2015-01-13, status=1, ipAttribution=)]
    2015-03-24 yangfl06

    #ABVD#

    0

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    2015-01-13 lifefamily

    不错的

    0

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    2015-01-13 lifefamily

    不错的

    0

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    2015-01-13 lifefamily

    同意楼上的

    0

  6. [GetPortalCommentsPageByObjectIdResponse(id=1827972, encodeId=b7f5182e9725a, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Oct 09 06:17:00 CST 2015, time=2015-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043682, encodeId=f3c6204368275, content=<a href='/topic/show?id=99ee1e88e3' target=_blank style='color:#2F92EE;'>#ABVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1788, encryptionId=99ee1e88e3, topicName=ABVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c2e485, createdName=yangfl06, createdTime=Tue Mar 24 05:17:00 CST 2015, time=2015-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14290, encodeId=a3dd14290db, content=不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:16:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14291, encodeId=072b1429174, content=不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:16:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14288, encodeId=f589142880d, content=同意楼上的, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:14:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14289, encodeId=aab21428920, content=同意楼上的, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:14:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14278, encodeId=2fb6142e86a, content=接下来应该对比AVD与ABVD方案, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=175.8.224.**, createdTime=Tue Jan 13 22:30:00 CST 2015, time=2015-01-13, status=1, ipAttribution=)]
    2015-01-13 lifefamily

    同意楼上的

    0

  7. [GetPortalCommentsPageByObjectIdResponse(id=1827972, encodeId=b7f5182e9725a, content=<a href='/topic/show?id=1b6210686b2' target=_blank style='color:#2F92EE;'>#Lancet#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=77, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=10686, encryptionId=1b6210686b2, topicName=Lancet)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=3f0227, createdName=howi, createdTime=Fri Oct 09 06:17:00 CST 2015, time=2015-10-09, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=2043682, encodeId=f3c6204368275, content=<a href='/topic/show?id=99ee1e88e3' target=_blank style='color:#2F92EE;'>#ABVD#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=93, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=1788, encryptionId=99ee1e88e3, topicName=ABVD)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=1c2e485, createdName=yangfl06, createdTime=Tue Mar 24 05:17:00 CST 2015, time=2015-03-24, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14290, encodeId=a3dd14290db, content=不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=129, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:16:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14291, encodeId=072b1429174, content=不错的, beContent=null, objectType=article, channel=null, level=null, likeNumber=138, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:16:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14288, encodeId=f589142880d, content=同意楼上的, beContent=null, objectType=article, channel=null, level=null, likeNumber=132, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:14:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14289, encodeId=aab21428920, content=同意楼上的, beContent=null, objectType=article, channel=null, level=null, likeNumber=153, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=lifefamily, createdTime=Tue Jan 13 23:14:00 CST 2015, time=2015-01-13, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=14278, encodeId=2fb6142e86a, content=接下来应该对比AVD与ABVD方案, beContent=null, objectType=article, channel=null, level=null, likeNumber=143, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=f0620, createdName=175.8.224.**, createdTime=Tue Jan 13 22:30:00 CST 2015, time=2015-01-13, status=1, ipAttribution=)]
    2015-01-13 175.8.224.**

    接下来应该对比AVD与ABVD方案

    0

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