地西他滨联合CAG方案与单纯CAG方案治疗中、高危骨髓增生异常综合征的疗效比较  

Comparison of Clinical Efficacy between Decitabine Combined with CAG Regimen and CAG Regimen Alone in Patients with Intermediate to High-risk Myelodysplastic Syndromes

作　　者：张云平[1,2] 吴文忠[2] 崔国兴[2] 

机构地区：[1]江苏大学医学院临床医学系,江苏镇江212001 [2]江苏大学附属宜兴市人民医院血液科,江苏宜兴214200

出　　处：《中国实验血液学杂志》2014年第5期1341-1344,共4页Journal of Experimental Hematology

摘　　要：本研究比较小剂量地西他滨联合CAG方案(阿克拉霉素、阿糖胞苷、粒细胞集落刺激因子)与单用CAG方案治疗中高危骨髓增生异常综合征的临床疗效及不良反应,探讨前方案作为中高危骨髓增生异常综合征新的治疗方法的可行性及有效性。2011年起小剂量地西他滨联合CAG治疗中高危骨髓增生异常综合征(MDS-RAEB)12例及2005年起既往单纯CAG方案治疗中高危MDS患者10例(治疗1个疗程后评估,至少使用2个疗程)疗效评估。分析接受两种方案的患者1个疗程的完全缓解率、总有效率、无病生存时间及总的生存时间。结果表明:小剂量地西他滨联合CAG方案治疗中高危MDS的12例患者一疗程后有完全缓解9例,2例部分缓解,1例完全无效,缓解率75.0%,总有效率91.7%,中位无病生存时间9(0-27)个月,中位总生存时间16(3-28)个月。治疗后肺部感染发生4例,予以抗感染治疗后均好转。既往2005年起10例中高危MDS患者予以单纯CAG方案治疗,完全缓解5例,部分缓解伴临床症状改善3例,2例无效,骨髓及血液学均无好转。缓解率50%,总有效率80%,中位无病生存时间6(0-18)个月,中位总生存时间13(3-31)个月。治疗后肺部感染3例,肠道感染1例,大肠杆菌败血症1例,予以积极抗感染治疗后均好转。两组患者治疗过程中未发生严重并发症,患者均能耐受,无治疗相关死亡。经统计分析,小剂量地西他滨联合CAG较单用CAG治疗中高危MDS有较长的无病生存时间(P值为0.013),总体生存时间有延长趋势,但无统计学意义(P值0.087)。结论:小剂量地西他滨联合CAG治疗中高危MDS有较高的治疗效果,不增加治疗风险,可在临床推广。This study was purposed to compare the clinical efficacy and adverse reactions of low-dose decitabine combined with CAG regimen （aclarubicin,Ara-C,and G-CSF） and CAG regimen alone in intermediate to high-risk myelodysplastic syndromes （MDS）,and evaluate the validity and efficacy of the former regimen as new treatment method of intermediate to high-risk myelodysplastic syndromes.A total of 12 patients with intermediate（IR） to high-risk （HR） MDS treated by low-dose decitabine combined with CAG regimen and 10 patients with IR to HR MDS treated by CAG regimen alone were evaluated after treatment of 1 cycle and at least after 2 cycles.The complete remission （CR） after 1 cycle,overall remission rate （ORR）,progression free survival （PFS） and overall survival （OS） between them were analyzed.The results showed that 9 patients treated by low-dose decitabine combined with CAG regimen achieved complete remission after 1 cycle,2 patients achieved partial remission,1 patient did not show reaction.The complete remission rate was 75.0% and overall response rate was 91.7%.The median time of disease free survival was 9 months （0-27 months）.The median overall survival time was 16 months（3-28 months）.4 patients suffered from pulmonary infection after treatment and then were all cured after treatment with anti-infective therapy.The 5 patients treated by CAG regimen alone achieved complete remission,3 patients achieved partial remission,2 patients showed non-reaction.The complete remission rate was 50.0% and overall response rate was 80.0%.The median time of disease free survival was 6 months（0-18 months）.The median overall survival time was 13 months（3-31 months）,4 patients suffered from pulmonary infection,1 patient suffered from enteric infection and 1 patient suffered from Escherichia coli septicemia after treatment,all of them becomed better after active treatment.Two groups of patients all had no serious adverse reactions,All patients could tolerate,no severe complication-related d

关 键 词：骨髓增生异常综合征 地西他滨 CAG方案 

分 类 号：R733.3[医药卫生—肿瘤]