改良CHG方案治疗成人高白细胞性急性髓系白血病  

Modified CHG regimen in treatment of newly diagnosed adult patients with hyperleukocytic acute myeloid leukemia

作　　者：张新华[1] 冉启杰[1] 周敏[1] 李菁媛[1] 王军[1] 徐彪[1] 宋森花[1] 马梅凌[1] 龚静[1] 刘龙龙[1] 谢红[1] 罗晓静[1] 

机构地区：[1]广州军区武汉总医院,武汉430070

出　　处：《内科急危重症杂志》2014年第3期170-172,共3页Journal of Critical Care In Internal Medicine

摘　　要：目的：观察改良CHG方案治疗初诊成人高白细胞性急性髓系白血病（HAML）的疗效及不良反应。方法：23例初诊成人HAML患者接受改良CHG方案化疗：高三尖杉酯碱（HHT）2mg／d，静脉滴注；阿糖胞苷（Ara—C）10mg／（m^2·d），皮下注射，1次／12h，共14d，化疗过程中，WBC〈10×10^9／L时予粒细胞集落刺激因子（G—CSF）300μg／d，皮下注射，直至中性粒细胞绝对值（ANC）≥1．5×10^9／L时停用。结果：15例（65．2％）获得完全缓解（CR），2例（8．7％）部分缓解（PR），总有效率（OR）73．9％。早期死亡2例，病死率8．7％。WBC计数降至10×10^9／L以下所需时间为6（4—10）d。化疗期间主要不良反应为骨髓抑制，表现为粒细胞缺乏及继发感染、出血。结论：改良CHG方案治疗初诊成人高白细胞性急性髓系白血病有效率高，不良反应可控制。Objective： To observe the efficacy and side effect of modified CHG regimen [ （ homoharringtonine （ HHT）, cytosine arabinoside （Ara-C） and grannlocyte colony stimulating factor（G-CSF） ] for treatment of the newly diagnosed adult patients with hyperleukocytic acute myeloid leukemia （HAML）. Methods： Twenty-three adult patients with HAML were treated with modified CHG regimen： HHT 2 mg/d intravenously; Ara-C 10mg/（ m2 · d） hypodermically once 12 hours for 14 days; and G-CSF 300 μg/d hypodermically when WBC 〈 10 ×10^9/L until absolute nentrophil count （ANC） ≥ 1.5×10^9/L. Results： Fifteen cases （65.2%） achieved complete remission （CR）, 2 cases （8.7%） partial remission （PR）, the overall response rate （OR） was 73.9%. Two of them died and the early mortality was 8.7%. The WBC counts decreased below 10 ×10^9/L necessitated 6 （4 - 10） days of modified CHG treatments. The main adverse effect during the chemotherapy was myelosuppression, manifested as neutropenia with secondary infection and bleeding. Conclusions： The efficacy of modified CHG regimen for newly diagnosed adult patients with HAML is rather high and the side effects are controllable.

关 键 词：急性髓系白血病 高白细胞性 高三尖杉酯碱 阿糖胞苷 粒细胞集落刺激因子 

分 类 号：R552[医药卫生—血液循环系统疾病]