地西他滨联合预激化疗对中老年MDS转化急性髓系白血病的近远期疗效及预后因素分析  

Efficacy of Decitabine Combined with Pre-Excitation Chemotherapy in the Treatment of Middle-Aged and Elderly MDS Transformed Acute Myeloid Leukemia

作　　者：李章坤[1] 赖应昌[1] 李坤[1] 何继祥[1] 姜义荣[1] 刘树阳[2] LI Zhang-Kun;LAI Ying-Chang;LI Kun;HE Ji-Xiang;JIANG Yi-Rong;LIU Shu-Yang(Department of Hematology,The People's Hospital of Dongguan City,Dongguan 523059,Guangdong Province,China;Department of Internal Medicine,The People's Hospital of Renhua County,Shaoguan 512300,Guangdong Province,China)

机构地区：[1]东莞市人民医院血液科,广东东莞523059 [2]韶关市仁化县人民医院内科,广东韶关512300

出　　处：《中国实验血液学杂志》2018年第6期1713-1718,共6页Journal of Experimental Hematology

基　　金：东莞市社会科技发展项目(201750715001297)

摘　　要：目的:探讨国产地西他滨联合预激化疗[粒细胞集落刺激因子(G-CSF)+吡柔比星(THP)+阿糖胞苷(Ara-C)](CTG方案)治疗中老年骨髓增生异常综合征(MDS)转化的急性髓系白血病(AML)的近远期疗效及预后因素。方法:选取2013年6月至2015年6月在东莞市人民医院收治的初诊中老年MDS转化AML患者共76例,依据治疗方法分为CTG治疗和地西他滨联合CTG治疗(联合治疗组)2组,CTG治疗组36例,联合治疗组40例,2组患者均接受4个疗程治疗,随后进行来那度胺维持治疗。比较2组的近远期疗效及不良反应发生率,同时探讨影响联合治疗的不良预后因素。结果:2组患者的年龄、性别、初始血细胞计数、骨髓原始细胞比例、疾病诊断分型、染色体核型及FLT3-ITD基因突变等基础临床特征均无显著性差异,联合治疗组的近期疗效优于CTG治疗组(ORR:72.5%vs 50%)(P<0.05),而骨髓抑制程度、严重感染发生率、胃肠道反应及肝损害方面,2组均无明显差异(P>0.05)。随访2年时间,联合治疗组的中位生存时间优于CTG治疗组(19.9 vs 11.0个月)(P<0.05)。多因素分析显示:近期疗效不佳(RR=3.926,P=0.015)、FLT3-ITD基因突变(RR=4.347,P=0.004)是影响联合治疗的独立危险因素。结论:国产地西他滨联合预激化疗治疗中老年MDS转化急性髓系白血病的近远期疗效均优于单纯预激化疗,而不良反应并未显著增加,其中近期疗效及FLT3-ITD基因突变是影响患者预后的独立危险因素。Objective: To investigate the efficacy of domestic decitabine (D) combined with pre-excitation chemotherapy consisted of Ara-c, THP and G-CSF(CTG) in treatment of middle-aged and elderly patients with MDS-transformed AML and prognosis-related factors.Methods: Seventy-six patients with MDS-transformed AML treated in our hospital from June 2013 to June 2015 were selected according to treatment regimens, 76 patients were divided into 2 groups: CTG group(36 cases) and D+CTG group(40 cases).The patients in CTG group received treatment with Ara-C, THP and G-CSF; the patients received the treatment with decitabine plus CTG.The patients in 2 groups all received 4 course treatment, then received maintaining treatment.The therapeutic efficacy and incidence of adverse reactions in 2 group were compared, at the same time, the risk factors affecting the prognos of patients treated with D+CTG were analyzed.Results: There were no siginificant differences in age, sex, initial blood cell count, bone marrow blast ratio, disease types, chromosome karyotypes and FLT3-ITD gene mutation between 2 groups.The efficacy analysis showed that the efficacy of D+CTG was superior to CTG, ORR in D+CTG group was significantly higher than that in CTG group (72、52 vs 50%) (P<0.05), moreover, no significant differences in bone marrow inhibition digree infeetion, gastroinfestinal response and liver damage were found between 2 groups (P>0.05).The follow-np for 2 years showed that the median survival time in D+CTG group was significantly longer than that in CTG group (19.9 vs 11.0 months) (P<0.05).The multivariate analysis showed that the 1 course efficacy (RR = 3.926, P= 0.015) and FLT3-ITD gene mutation (RR = 4.347,P = 0.004) were independent risk factors affecting the efficacy of D+CTG treatment.Conclusion: The short-and longterm efficacy of domestic decitasine combined with preexcitation chenotherapy in treatment of middec-aged and eldery patients with MDS transformed AML is superior to single pre-excitation chenothrapy, moreover the incidence o

关 键 词：地西他滨 预激化疗 中老年 骨髓增生异常综合征 急性髓细胞白血病 

分 类 号：R733.71[医药卫生—肿瘤] R733.3[医药卫生—临床医学]