HAG与CAG预激方案治疗高危骨髓增生异常综合征的疗效比较  

Comparison of efficacy of HAG and CAG priming regimen for patients with high-risk myelodysplastic syndrome

作　　者：王芳侠[1] 白菊[1] 何爱丽[1] 张王刚[1] 曹星梅[1] 陈银霞[1] 刘捷[1] 赵万红[1] 马肖容[1] 杨云[1] 王剑利[1] 张鹏宇[1] 古流芳[1] 雷博[1] 王瑾[1] 

机构地区：[1]西安交通大学第二附属医院血液科,西安710004

出　　处：《山西医科大学学报》2016年第3期277-280,共4页Journal of Shanxi Medical University

基　　金：西安交通大学自由探索与自主创新类资助项目(08143009)

摘　　要：目的比较高三尖杉酯碱（HHT）、阿糖胞苷（Ara-c）联合粒细胞集落刺激因子（G-CSF）的小剂量预激化疗方案（HAG方案）与阿克拉霉素（aclacinomycin）、Ara-c联合G-CSF的CAG方案治疗高危骨髓增生异常综合征（MDS）的效果及其安全性。方法 52例初诊的高危MDS患者入选HAG方案组,50例初诊的高危MDS患者入选CAG组。1个疗程后初步评价疗效,未缓解者进行第2个疗程,2个疗程后评价治疗效果及不良反应。结果 ①HAG组2疗程后共25例获完全缓解（CR）（48.1%）,11例获部分缓解（PR）（21.2%）,总有效率69.2%。CAG组2疗程后23例获CR（46.0%）,9例获PR（18.0%）,总有效率64.0%。经统计学检验,HAG与CAG方案组比较无统计学差异。②HAG组在诱导治疗期间发生粒细胞缺乏的比例为53.8%（28例）,平均持续时间4 d,血小板〈20×10^9/L的比例为34.6%（18例）,平均持续时间5 d;CAG组诱导治疗期间发生粒细胞缺乏的比例为58.0%（29例）,平均持续时间6 d,血小板〈20×10^9/L的比例为38.0%（19例）,平均持续时间7 d。结论 HAG及CAG预激方案治疗高危MDS均能取得较高的缓解率,HAG预激方案骨髓抑制较轻,临床应用较为安全,值得推广应用。Objective To compare the efficacy and safety of low-dose priming regimens,HAG[homoharringtonine,cytarabine and granulocyte colony-stimulating factor（ G-CSF） ]versus CAG（ aclacinomycin,cytarabine and G-CSF） for the patients with high-risk myelodysplastic syndrome（ MDS）. Methods Fifty-two newly diagnosed adult patients with high-risk MDS were enrolled and treated with the HAG regimen,and fifty newly diagnosed patients with high-risk MDS were enrolled and treated with the CAG regimen. The efficacy was evaluated after a cycle,and the non-remission patients were given a second cycle and then the efficacy and the side effects were evaluated. Results①A total of 25 patients（ 48. 1%） achieved complete response（ CR） and 11 patients（ 21. 2%） achieved partial response（ PR） after two courses of HAG regimen,and the total effective rate was 69. 2%. A total of 23 patients（ 46. 0%） achieved CR and 9 patients（ 18. 0%） achieved PR after two courses of CAG regimen,and the total effective rate was 64. 0%. There was no statistical difference in the effective rate between HAG and CAG.②In the induction therapy of HAG regimen,a total of 28 patients（ 53. 8 %） experienced neutropenia（ median duration： 4 d）,and 18 patients（ 34. 6%） experienced platelets less than 20 × 10^9/ L（ median duration：5 d）. In the CAG regimen,a total of 29 patients（ 58. 0%） experienced neutropenia（ median duration： 6 d）,and 19 patients（ 38. 0%）experienced platelets less than 20 × 10^9/ L（ median duration： 7 d）. Conclusion The low-dose HAG chemotherapy regimen is as effective as CAG regimen in induction therapy for high-risk MDS,with slight myelosuppression and nonhematologic toxicities.

关 键 词：骨髓增生异常综合征 预激 高三尖杉酯碱 阿糖胞苷 阿克拉霉素 

分 类 号：R551.3[医药卫生—血液循环系统疾病]