地西他滨联合化疗治疗难治复发急性髓系白血病及骨髓增生异常综合征转化白血病的效果观察  

Clinical effects of decitabine combined with chemotherapy in the treatment of patients with refractory and relapsed acute myeloid leukemia and myelodysplastic syndrome transformed leukemia

作　　者：韩波[1] 王朝晖[1] 邵纬[2] 王九河[1] 洪青[1] 范传波[1] 刘俊玲[1] 田猛[1] 王海霞[1] 乌庆超[1] 

机构地区：[1]青岛海慈医疗集团血液科,266033 [2]青岛海慈医疗集团肿瘤科,266033

出　　处：《白血病．淋巴瘤》2014年第12期733-736,共4页Journal of Leukemia & Lymphoma

摘　　要：目的 探讨地西他滨联合化疗治疗难治复发急性髓系白血病（AML）及骨髓增生异常综合征（MDS）转化AML的临床效果.方法 选取2013年2月至2014年3月住院治疗的难治复发AML患者19例及MDS转化AML患者4例,所有患者给予地西他滨联合CAG方案进行治疗,评估患者治疗效果及不良反应.结果 经过1个疗程治疗后,14例（60.9％）完全缓解,2例（8.7％）部分缓解,7例（30.4％）无效,总有效率69.6％,不同染色体核型患者临床治疗效果差异具有统计学意义（P＜0.05）.23例患者出现不同程度的骨髓抑制,其中Ⅰ～Ⅱ级中性粒细胞减少2例,Ⅲ～Ⅳ级21例,中性粒细胞减少中位时间13 d;Ⅲ～Ⅳ级贫血23例;Ⅲ～Ⅳ级血小板减少23例,血小板减少中位时间16d.Ⅰ～Ⅱ级出血20例,Ⅲ～Ⅳ级3例.Ⅰ～Ⅱ级胃肠道反应1例.Ⅰ～Ⅱ级肝功能异常1例.所有患者随访至2014年3月31日,生存20例,死亡3例,中位总生存期3.1个月,1年累积生存率86％.结论 地西他滨联合化疗治疗难治复发AML及MDS转化白血病的临床缓解率高,不良反应少;染色体核型可能是影响治疗效果的重要因素.Objective To investigate the clinical effects of decitabine combined with chemotherapy in the treatment of patients with refractory and relapsed acute myeloid leukemia （AML） and myelodysplastic syndrome （MDS） transformed leukemia.Methods 19 patients with refractory and relapsed AML and 4 cases of patients with MDS transformed AML were enrolled from February 2013 to March 2014.All cases were treated with decitabine combined with CAG regimen.The clinical effects and adverse reactions were evaluated.Results After a course of treatment,14 cases （60.9 %） were complete remission,2 cases （8.7 %） were parrtial remission,7 cases （30.4 %） were non-remission,and the total efficiency rate was 69.6 %.The differences of clinical outcomes among different karyotypes were statistically significant （P 〈 0.05）.There were varied degree of bone marrow suppression among 23 patient,including 2 cases were Ⅰ-Ⅱ grade,21 cases were Ⅲ-Ⅳ grade neutropenia.The neutrophil cells median reduce time was 13 d.23 cases were Ⅲ-Ⅳ grade anemia.23 cases were Ⅲ-Ⅳ grade thrombocytopenia.The Plt median reduce time was 16 d.20 cases were Ⅰ-Ⅱ grade bleeding,and 3 cases were lⅢ-Ⅳ grade.1 case was Ⅰ-Ⅱ grade gastrointestina reactions.1 case was Ⅰ-Ⅱ grade abnormal liver function.All patients were followed-up until March 31,2014,and 20 cases were survival,3 cases were deaths.The median overall survival time was 3.1 months,1-year cumulative survival rate was 86 %.Conclusions Decitabine combined with chemotherapy used in refractory and relapsed AML and MDS transformed leukemia has high clinical remission rate,and has fewer adverse reactions.Karyotype might be an important factor affecting the therapeutic effect.

关 键 词：白血病 髓样 急性 骨髓增生异常综合征转化白血病 难治 复发 地西他滨 药物疗法 

分 类 号：R733.71[医药卫生—肿瘤]