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標題: | 單次引導性L-asparaginase於高風險貓隻中大型淋巴瘤之回溯性研究 A Retrospective Evaluation of Short Induction L-asparaginase in High Risk Feline Medium to Large Cell Lymphoma |
作者: | 林亦真 Yi-Chen Lin |
指導教授: | 李繼忠 Jih-Jong Lee |
關鍵字: | 貓隻中大型淋巴瘤,化療,單次引導性L-asparaginase, Feline medium to large cell lymphoma,L-asparaginase,Chemotherapy, |
出版年 : | 2023 |
學位: | 碩士 |
摘要: | 貓中大型細胞淋巴瘤為最常見的貓隻血液疾病之一,多種藥物組合之化學治療目前已被廣泛使用,達30-80 %腫瘤消退率及97-213天的中位存活時間。雖然此化學治療目前對於大部分患病貓隻耐受度良好,但若貓隻已有系統性臨床症狀或化療風險為高風險者,其毒性與化療後副作用仍為化療風險考量之一。為了減少治療風險,以l-asparaginase作為單次引導性之治療因此被提出。本研究的目的為評估在患有中大型細胞淋巴瘤的化療高風險貓隻施打l-asparaginase其副作用及反應,並同時比較疾病無惡化存活期及生存時間的差異性。
本研究方法以回溯性研究收集自2018年三月至2023年三月於國立臺灣大學生物資源暨農學院附設動物醫院內,透過細胞學或病理學診斷為中大型細胞淋巴瘤之貓隻病歷資料進行分析,最終共計30隻貓隻符合收案條件而納入研究。在疾病無惡化存活期的單變量統計中,貓隻有多器官腫瘤浸潤相較單一器官浸潤者有顯著疾病、疾病分期與施打l-asparaginase的反應有顯著差異(P=0.001及0.017及0.033); 在存活時間的單變量分析中,腫瘤器官浸潤與臨床分期有顯著差異(P=0.033及0.001)。原發解剖位置、免疫分型、體重變化、類固醇劑量、是否呈現食慾不振、呈現貧血、呈現白血球上升及呈現氮血症則無顯著差異。多變量分析中,疾病無惡化存活期在臨床分期、對於施打l-asparaginase的反應仍有顯著差異(P =0.017及0.007);存活時間則是在腫瘤浸潤器官數量與臨床分期上有顯著差異(P =0.048及0.033)。在貓隻進行l-asparaginase施打後無貓隻出現過敏、白血球低下及腸胃道不適等副作用,其腫瘤整體反應率對於l-asparaginase單次引導性治療為83%。 在後續追蹤當中,貓隻繼續接受以傳統化學治療者則相較無接受化療者其疾病無惡化存活期及存活時間亦有顯著差異(P =0.016及0.028),在有接受傳統化療的貓隻的疾病無惡化期155天, 無接受者則為56天;另外有接受化療者存活時間為140天,而未接受化療組合者則為50天。 總體而言,l-asparaginase在患有中大型淋巴瘤的化療高風險貓隻進行單次引導性施打為安全且有效益之治療,根據我們的研究結果,在給予l-asparaginase治療過後有臨床反應者,其無疾病存活期亦有顯著差異,因此,以單次引導l-asparaginase治療可能可為化療高風險淋巴瘤病貓隻帶來臨床益處。 Feline medium-large cell lymphoma is one of the most common hematopoietic neoplasms in cats. CHOP-based (cyclophosphamide, doxorubicin, vincristine, prednisolone or prednisone) or COP-based (cyclophosphamide, vincristine, prednisolone or prednisone) protocols were most used, and the overall response rate was 30-80 % with median survival time ranged from 97 to 213 days. Although most cats can tolerate the treatment, the toxicity in substage b and high-risk patients remains the concern of conventional treatment. To decrease the toxicity of treatment, a modified treatment with short induction of l-asparaginase in feline lymphoma has been studied. This study aimed to determine that l-asparaginase administration was effective and less toxic in high risk patient with feline medium-large cell lymphoma at National Taiwan University Veterinary Hospital (NTUVH). The progression-free survival (PFS) and overall survival time (OST) were also evaluated. Medical records of cats cytologically or histologically diagnosed with medium to large cell lymphoma in NTUVH Animal Cancer Treatment Center between March 2018 and March 2023 were reviewed retrospectively. A total of thirty cats who met the inclusion criteria were enrolled. In univariate analysis for PFS, cats with multiple organs involvement in initial clinical presentation, clinical stage and the response to l-asparaginase administration had significant analysis difference (P =0.001, 0.017 and 0.033, respectively). In univariate analysis for OST, the numbers of organs involvement and clinical stage had significant analysis difference (P =0.033 and 0.001, respectively). The anatomical site, immunophenotype, presence of anorexia, anemia, leukocytosis, and azotemia were not significantly affecting PFS and OST. In multivariate analysis for PFS, clinical stage and the response to l-asparaginase administration was still significant difference (P=0.017and 0.007, respectively). On the other hand, in multivariate analysis for OST, organ involvement and clinical stage was significant difference (P=0.048 and 0.033, respectively). No cats had hypersensitivity reactions nor neutropenia nor gastrointestinal discomfort after l -asparaginase administration. The overall response rate of l-asparaginase administration was 83 %. In the follow-up aspect, cats who received conventional chemotherapy had significantly longer PFS and OST than those who did not (P=0.016 and 0.028). The median PFS is 155 days versus 56 days, while the median OST is 140 days versus 50 days. In conclusion, l-asparaginase administration as short induction was effective and less toxic in high risk cats with medium-large cell lymphoma. Based on the result, the response after l -asparaginase treatment was also a prognostic factor in our study. Therefore, prior use of l-asparaginase as short induction treatment before conventional chemotherapy in high risk cats with medium-large cell lymphoma may provide more clinical benefit for the patients. |
URI: | http://tdr.lib.ntu.edu.tw/jspui/handle/123456789/91959 |
DOI: | 10.6342/NTU202302847 |
全文授權: | 同意授權(限校園內公開) |
顯示於系所單位: | 臨床動物醫學研究所 |
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