地西他滨治疗骨髓增生异常综合征和急性髓细胞白血病临床观察  

Clinical observation of decitabine for myelodysplastic syndrome and acute myeloid leukemia

作　　者：李亚茹[1] 任翠爱[2] 侯丽雪[2] 崔景英[2] 徐文君[2] 

机构地区：[1]潍坊医学院,山东潍坊261042 [2]潍坊市人民医院血液内科,山东潍坊261042

出　　处：《现代医药卫生》2014年第8期1132-1134,共3页Journal of Modern Medicine & Health

摘　　要：目的探讨地西他滨治疗骨髓增生异常综合征（MDS）和急性髓细胞白血病（AML）的临床疗效和安全性。方法收集2011年1月至2013年7月接受地西他滨[15mg／（m2·d），第1—5天，静脉滴注持续1h以上1单药或联合CAGf阿糖胞苷（Ara-C）、阿克拉霉素（Acla）、粒细胞集落刺激因子（G-CSF）]方案治疗的20例MDS和AML患者的临床资料，评价其疗效和不良反应。结果20例患者中完全缓解（CR）4例，部分缓解（PR）8例，稳定（SD）及进展（PD）8例，总有效率为60．0％（12／20）。其中12例AML患者中CR2例，PR5例，总有效率为58.3％（7／12），8例MDS患者中CR2例，PR3例，总有效率为62．5％（5／8）。1例MDS．难治性贫血伴环状铁粒幼细胞患者和2例慢性粒一单核细胞性白血病患者输血依赖情况有所改善。14例患者出现Ⅲ－Ⅳ度骨髓受抑，发生率为70．O％（14／20）。总感染率为35．0％（7，20），其中肺部感染率为20．0％（4／20），患者经积极抗感染、刺激造血及输血等支持治疗后感染控制。1例患者出现化疗相关死亡。20例患者均未出现严重肝功能损害及出血。结论地西他滨单药或联合CAG方案治疗MDS和AML有一定疗效，可廷缓疾病进展；患者对化疗不良反应均能耐受．且化疗相关病死率低。Objective To explore the clinical efficacy and safety of decitabine for myelodysplastic syndrome （MDS） and acute myeloid leukemia（AML）. Methods Collecting the clinical data of 20 patients with MDS/AML from January 2011 to July 2013 ,who were received the therapeutic regimen with decitabine 15mg/（m2. d） by intravenous infusion over 1 h for five consecu tire days or combined with CAG [cytosine arabinoside （Ara-C）, aclacinomycin （Acla） and granulocyte colony stimulating factor （G-CSF）]. The clinical efficacy and adverse effects were evaluated. Results Among the 20 patients, 4 cases were of complete re- mission （CR）, 8 cases achieved partial remission （PR） and 8 cases of stable disease （SD） and progressive disease （PD） with the total effective rate of 60% （12/20）. Among the 12 patients with AML, 2 cases were of CR and 5 cases of PR with the total effective rate of 58.3%（7/12）. Among the 8 patients with MDS ,2 cases were of CR and 3 cases of PR with the total effective rate of 62.5% （5/8）. The transfusion dependency was improved in 3 patients, in which, one with MDS-refractory anemia with ring sideroblast and two with chronic myelomonocytic leukemia. Grade m-IV bone marrow depression occurred in 14 cases with incidence rate of 70% （14/20）, and the total incidence rate of infection was 35% （7/20）, including lung infection of 20% （4/20）, the infection was con- trolled after active supportive treatments with anti-infection,hematopoietic stimulating and blood transfusion. No severe livery in- jury and bleeding occurred. 1 patient died due to chemotherapy. Conclusion Decitabine or combined with CAG regimen can ef- fectively treat MDS/AML in some extent and delay the development of diseases. The patients can tolerate the adverse effect in chemotherapy with a low mortality rate.

关 键 词：骨髓增生异常综合征 白血病 髓样 急性 阿糖胞苷 粒细胞集落刺激因子 地西他滨 阿克 拉霉素 

分 类 号：R551.3[医药卫生—血液循环系统疾病]