Etoposide produces reversible inhibition of topoisomerase II, leading to cleavage of DNA, and thereby has an antitumor effect. This mechanism suggests that the longer treatment is continued, the greater the antitumor effect will be. In the present study, both therapeutic and adverse effects of long-term treatment with low-dose oral etoposide were studied in 29 patients aged > or = 65 years with non-Hodgkin's lymphoma (NHL) for whom standard chemotherapy was not effective or refractory. These patients received etoposide at a dose of 50 mg/d for as long as possible. Treatment was continued until white blood cell count decreased to < or = 2,000/microL or the platelet count decreased to < or = 5 x 10(4)/microL. According to the World Health Organization (WHO) criteria of therapeutic effects, 6 (20.7%) of the 29 patients achieved complete remission and 13 patients (44.8%) had partial remission, for a response rate of 65.5%. Adverse effects of > or = grade 3 included leukopenia in 24 patients (82.8%) and anemia in 7 (24.1%). Granulocyte colony-stimulating factor (G-CSF) was given in combination with etoposide to eight patients because of leukopenia (granulocyte count < or = 1,000/microL). In view of the excellent subjective tolerance, low incidence of serious adverse effects, and good activity, single agent oral etoposide given continuously over prolonged periods represents a useful treatment for elderly patients with NHL.

译文

依托泊苷产生拓扑异构酶II的可逆抑制,导致DNA裂解,从而具有抗肿瘤作用。这种机制表明,持续治疗的时间越长,抗肿瘤作用就越大。在本研究中,对29例年龄> 或 = 65岁的非霍奇金淋巴瘤 (NHL) 患者进行了低剂量口服依托泊苷长期治疗的治疗和不良反应的研究,这些患者的标准化疗无效或难治性。这些患者尽可能长时间地接受依托泊苷50 mg/d的剂量。继续治疗直到白细胞计数降低至 <或 = 2,000/microL或血小板计数降低至 <或 = 5 × 10(4)/microL。根据治疗效果的世卫组织标准,29例患者中有6例 (20.7% 例) 完全缓解,13例 (44.8% 例) 部分缓解,缓解率为65.5%。> or = 3级的不良反应包括白细胞减少24例 (82.8%) 和贫血7例 (24.1%)。由于白细胞减少 (粒细胞计数 <或 = 1,000/microL),将八名患者与依托泊苷联合给予粒细胞集落刺激因子 (g-csf)。鉴于其良好的主观耐受性,低的严重不良反应发生率和良好的活性,长期连续给予单药口服依托泊苷代表了对老年NHL患者的有用治疗。

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