地西他滨单药或联合以阿糖胞苷为基础的低剂量化疗方案治疗老年急性髓系白血病的临床分析  

Clinical Efficacy of Decitabine Combined with or without Cytarabine-based Low Dose Regimen for Senile patients with Acute Myeloid Leukemia

作　　者：周宏伟[1] 周敏航[1] 王志红[1] 李鹏飞[1] 刘默[1] 杜瑜[2] 姚毅冰 彭朝津[1] 靖彧[3] 孙君重[1] 

机构地区：[1]解放军总医院第一附属医院老年肿瘤科,北京100048 [2]解放军总医院第一附属医院放疗科,北京100048 [3]解放军总医院血液科,北京100853

出　　处：《中国实验血液学杂志》2018年第1期91-96,共6页Journal of Experimental Hematology

基　　金：解放军总医院临床科研扶持基金"三〇四"专项(编号:2015FC-TSYS-3046)

摘　　要：目的:观察地西他滨(DAC)单药或联合以阿糖胞苷为基础的低剂量化疗方案治疗老年急性髓系白血病(AML)患者的疗效和不良反应。方法:回顾性分析2009年9月至2012年3月我科收治的8例初治老年(年龄>70岁)AM L患者的临床特征,包括年龄、性别、外周血及骨髓特点等。应用低剂量DAC±以阿糖胞苷为基础的低剂量化疗方案化疗(DAC 20 mg/m^2·d 1-5±以阿糖胞苷20 mg/d d3-9为基础的化疗方案),观察治疗效果及不良反应。结果:8例患者,男3例,女5例,年龄71-84岁,初治时白细胞中位数31.2(1.38-179)×10~9/L,骨髓原始细胞百分比中位数42.7(23-94)%。接受了DAC±以阿糖胞苷为基础的低剂量化疗方案化疗的中位疗程数为2.5(1-20)个。完全缓解2例,部分缓解2例,总缓解率为50%(4/8),中位OS为9.5(2-36)个月,3例患者的总生存时间达到或超过了1年,8周内死亡1例。主要的严重不良反应是骨髓抑制(Ⅲ-Ⅳ度87.5%)和肺部感染(50%)。结论:低剂量DAC±以阿糖胞苷为基础的低剂量化疗方案治疗老年(年龄>70岁)AML,明显提高了有效率,延长了患者生存期,患者耐受性良好,疗效满意。Objective： To investigate the therapeutic effectiveness and side effects of decitabine combined with or without cytarabine-based lowdose regimen for acute myeloid leukemia in geratic patients. Methods： Clinical data of 8 geratic patients（ aged over 70 years） suffered from acute myeloid leukemia from September 2009 to March 2012 were analyzed retrospectively,including age,sex,peripheral blood and bone marrowcharacteristics and so on. These patients were treated by an 1-hour intravenous infusion of decitabine 20 mg/m^2 per day for 5 consecutive days every 4 weeks combined with or without lowdose regimen dominantly consisting of cytarabine 20 mg per day as subcutaneous injection for seven consecutive days. The therapeutic effectiveness and side-effects were evaluated. Results： Among 8 patients,incinding 3 males and 5 females aged between 71-84 years old,their median white blood cell count was 31. 2（ 1. 38-179） × 10^9/L,and median bone marrowblast cell ratio was 42. 7（ 23-94） % at the initial diagnosis. The median treatment courses was 2. 5（ 1-20）. After treatment by this protocol,2 patients achieved complete remission（ CR）（ 25%）,2 patients achieved partial remission（ PR）（ 25%）,3 were not relieved,and 1 died,thus the overall response rate reached to 50%（ 4/8）. The median overall survival time was 9. 5（ 2-36） months,and the overall survival time of 3 patients reached 1 year or more. The main side-effects of treatment were grade Ⅲ-Ⅳ of myelosuppression（ 87. 5%）and pneumonia（ 50%）. Conclusion： Decitabine combined with or without cytarabine-based lowdose regimen is promising for the treatment of geriatric acute myeloid leukemia,thus improving the overall response rate,and prolonging overall survival time.

关 键 词：地西他滨 老年急性髓系白血病 阿糖胞苷 骨髓抑制 

分 类 号：R733.71[医药卫生—肿瘤]