地西他滨联合减量米托蒽醌+阿糖胞苷方案治疗复发难治性急性髓系白血病的临床疗效及安全性分析  

Clinical Efficacy and Safety of Decitabine Combined With Low-dose Mitoxantron Plus Cytarabine in the Treatment of Recurrent and Refractory Acute Myeloid Leukemia

作　　者：丁卓玲[1] 邓明凤[2] 唐元艳[3] 黄俊[2] 陈永玲[2] 张利铭[3] 

机构地区：[1]华中科技大学同济医学院附属荆州医院药剂科,湖北省荆州市434020 [2]华中科技大学同济医学院附属荆州医院检验医学部,湖北省荆州市434020 [3]华中科技大学同济医学院附属荆州医院血液科,湖北省荆州市434020

出　　处：《中国全科医学》2016年第6期702-705,共4页Chinese General Practice

摘　　要：目的观察地西他滨（DAC）联合减量米托蒽醌＋阿糖胞苷（MA）方案（简称DAC联合方案）治疗复发难治性急性髓系白血病（AML）患者的疗效及安全性。方法选取2011年8月—2013年5月华中科技大学同济医学院附属荆州医院收治的复发难治性AML患者12例,以DAC联合方案治疗〔第1-5天地西他滨20 mg·（m2）-1·d-1,静脉滴注;第6-8天米托蒽醌8-12 mg/m2,静脉滴注;第6-8天、第10天阿糖胞苷100 mg/m2,静脉滴注〕。治疗前后观察患者血液学指标〔白细胞计数、血红蛋白（Hb）、血小板计数〕、外周血白细胞中原始和/或幼单核细胞比例（%）、骨髓有核细胞中原始和/或幼单核细胞比例（%）,骨髓细胞遗传学变化：染色体异常率、细胞遗传学缓解有效率,记录患者生存状况（自治疗结束随访至2013年12月）及毒副作用。结果治疗前后复发难治性AML患者Hb、血小板计数、外周血白细胞中原始和/或幼单核细胞比例、骨髓有核细胞中原始和/或幼单核细胞比例比较,差异均有统计学意义（P〈0.05）。复发难治性AML患者经1个疗程DAC联合方案治疗后,完全缓解（CR）4例（33.3%）、部分缓解（PR）3例（25.0%）、未缓解（NR）5例（41.7%）,缓解总有效率（ORR）为58.3%（7/12）。5例染色体异常（异常率为41.7%）患者治疗后1例获完全细胞遗传学缓解,2例部分细胞遗传学缓解,细胞遗传学缓解有效率为60.0%（3/5）。毒副作用主要为骨髓抑制及继发感染,经过输血和抗感染等支持治疗均可以耐受。患者中位生存时间为8.0个月。结论 DAC联合方案治疗复发难治性AML在血液学及细胞遗传学上可以获得较好疗效,且毒副作用较少,耐受性良好,可为临床治疗提供借鉴。Objective To investigate the clinical efficacy and safety of decitabine（ DAC） combined with low- dose mitoxantrone plus cytarabine（ MA）（ briefly called DAC combined therapy） in the treatment of recurrent and refractory acute myeloid leukemia（ AML）. Methods Enrolled 12 patients with recurrent and refractory AML who were complete in the Jingzhou Hospital Affiliated to Tongji Medical College, Huazhong University of Science and Technology from August 2011 to May2013. DAC combined therapy was undertaken on the patients 〔intravenous drip of DAC by 20 mg·（ m2）- 1·d- 1from day 1 to day 5; intravenous drip of mitoxantrone by 8- 12 mg / m2 from day 6 to day 8; intravenous drip of cytarabine by 100 mg / m2 from day 6 to day 8 and on day 10 〕. Before and after treatment, haematological indexes（ white blood cell count, Hb and blood platelet count）,the proportion of monoblasts and / or infantile monocytes among peripheral blood leukocytes,the proportion of monoblasts and / or infantile monocytes among bone marrow nucleated cells,genetic changes of bone marrow cells,chromosome abnormality rate and effective rate of cytogenetic responses. The survival status（ from the end of treatment till December 2013） and adverse effects of patients were recorded. Results After treatment,Hb,blood platelet count,the proportion of monoblasts and/ or infantile monocytes among peripheral blood leukocytes,the proportion of monoblasts and / or infantile monocytes among bone marrow nucleated cells changed significantly compared with those before treatment（ P〈0. 05）. After treatment,4（ 33. 3%）patients had complete cytogenetic responses,3（ 25. 0%） had partial cytogenetic responses,5（ 41. 7%） had no cytogenetic responses,and the hematologic overall response rate was 58. 3%（ 7 /12）. Among the 5（ 41. 7%） patients with chromosome abnormality,1 patient had complete cytogenetic responses and 2 patients had partial cytogenetic responses after treatment,with a total response rate of 60. 0%（ 3 /5）

关 键 词：白血病 髓样 急性 地西他滨 米托蒽醌 阿糖胞苷 药物毒性 治疗结果 

分 类 号：R733.71[医药卫生—肿瘤]