超低剂量地西他滨联合自体CIK细胞输注治疗骨髓增生异常综合征转化的高龄急性髓细胞白血病1例并文献复习  

Treatment of an elderly patient with acute myelocytic leukemia transformed from myelodysplastic syndrome with decitabine in ultra-low dosage combining with transfusion of autologous cytokineinduced killer cells:a case report and review of literature

作　　者：杨波[1] 蔡力力[2] 汪海涛[1] 朱宏丽[1] 迟小华[3] 于睿莉[4] 杨洋[1] 冉海红[1] 辛丽君[1] 姚善谦[1] 卢学春[1] 

机构地区：[1]解放军总医院南楼血液科,北京100853 [2]解放军总医院南楼临检科,北京100853 [3]解放军第二炮兵总医院药剂科,北京100088 [4]解放军总医院耳鼻咽喉研究所,北京100853

出　　处：《解放军医学杂志》2014年第4期315-319,共5页Medical Journal of Chinese People's Liberation Army

基　　金：国家自然科学基金(81273597;81302801;81172986);解放军总医院科技创新苗圃基金(11KMM24;13KMM18);解放军总医院临床科研扶持基金(2012FC-TSYS-4010);军队"十二五"保健基金(13BJZ47)~~

摘　　要：目的观察超低剂量地西他滨联合自体细胞因子诱导的杀伤细胞（CIK）治疗骨髓增生异常综合征（MDS）转化的老年急性髓细胞白血病（AML）的安全性及疗效。方法患者男，83岁，初诊为骨髓增生异常综合征．难治性贫血（MDS．RA），采用氨磷汀联合红细胞生成素治疗，血象维持基本正常3年半，后病情进展，转变为慢性粒单细胞白血病，2个月后又演变为AML．M4型，采用超低剂量地西他滨联合白体CIK细胞治疗，具体方案为：地西他滨10mgd1．5，CIK输注（每次2×10^9～8×10^9）d14，rhlL-22mUd15-19，28d为1个周期。观察治疗后的不良反应、血象变化、缓解情况及生存期，并复习有关地西他滨治疗老年MDS／AML的相关文献。结果患者在最佳支持治疗的基础上，共完成8个周期地西他滨联合自体CIK输注治疗，期间出现Ⅰ／Ⅱ度骨髓抑制及Ⅰ度胃肠道反应，肝肾功能无明显异常，分别于第2、3、8周期出现高白细胞血症（最高达141．95×10^9／L），加用依托泊苷（50mg，d1-3）治疗后高白细胞血症得到控制。在间断输血治疗下血红蛋白维持在77～138g／L，血小板在第3周期后开始上升，至第6周期达到正常，疗效评价达到部分缓解。患者最终死于白血病进展和肺部感染，自诊断AML至死亡共生存22个月，显著长于文献报道。结论超低剂量地西他滨联合自体CIK细胞治疗老年MDS转化的AML安全有效，有必要扩大病例数深入研究。Objective To investigate the efficacy and safety of decitabine in ultra-low dose combining with autologous cytokine-induced killer （CIK） cells for treatment of elderly patients with acute myelocytic leukemia （AML） transformed from myelodysplastic syndrome （MDS）. Methods An 83-year-old patient with initial diagnosis of MDS-RA was treated with amifostine combined with erythropoietin （EPO）, and hemogram was improved nearly to normal lasting about three and a half years. Then the patient＇s morbidity transformed to chronic myelomonocytic leukemia （AML-M4） two months later. Then the patient was treated with an ultra-low dose of decitabine combining with autologous CIK cells. The detailed treatment included decitabine 10mg, dl-5, and CIK cells transfusion （2 × 10^9-8 × 10^9 each time） d14; rhlL-2 2mU d15-19.28-day treatment was accounted as one treatment course. Side effects, changes in hemogram, signs of recuperation and duration of survival were systematically observed. Further, the literature concerning decitabine for the treatment of elderly patients with MDS/AML was reviewed. Results In total, 8 cycles of decitabine combining with autologous CIK cells were given in addition to the best supportive treatments available. During treatment, side reactions including Ⅰ / Ⅱ grade bone marrow inhibition and grade Ⅰ gastrointestinal reaction were observed. No obvious signs of dysfunction were found in liver and kidney. Leukocytosis appeared during 2nd, 3rd and 8th cycles of treatment, with the highest white blood cells count of 141.95 × 10^9/L, and it could be controlled by giving etoposide （50rag, dl-3）. Hemoglobin content varied between 77 and 138g/L in the context of intermittent blood transfusion. During 3rd treatment, platelets started to increase in number, but reaching normal level during 6th treatment cycle. It was evaluated as partial remission. Finally, the patient died due to deterioration in leukemia and pneumonia. The overall survival duration was 22 months from diagnosis o

关 键 词：白血病 粒细胞 急性 骨髓增生异常综合征 地西他滨 细胞因子诱导的杀伤细胞 老年人 

分 类 号：R557.2[医药卫生—血液循环系统疾病]