以地西他滨为主的化疗方案治疗初治中、老年急性髓系白血病的临床研究  

Clinical Efficacy of Decitabine-Based Chemotherapy Regimens in the Treatment of Newly Diagnosed Elderly Patients with Acute Myeloid Leukemia

作　　者：李国辉[1] 陈任安[1] 及月茹[1] 秦炜炜[1] 陈怡[1] 王文清[1] 刘聪 周柰岑[1] 刘利[1] L;CHEN Ren-An;JI Yue-Ru;QIN Wei-Wei;CHEN Yi;WANG Wen-Qing;LIU Cong;ZHOU Nai-Cen;LIU Li(Department of Hematology, Tangdu Hospital, Fourth Military Medical University, Xian 710038, Shaanxi Province, China)

机构地区：[1]第四军医大学唐都医院血液科,陕西西安710038

出　　处：《中国实验血液学杂志》2018年第3期743-749,共7页Journal of Experimental Hematology

基　　金：国家自然科学基金青年科学基金项目(81100354)

摘　　要：目的:研究以地西他滨为主的化疗方案治疗初治中、老年急性髓系白血病(AML)的安全性及有效性。方法:选取2013年1月-2016年12月就诊于本院年龄大于50岁的初诊急性髓系白血病患者(除M3)49例(所有患者均因各种原因不适合行异基因造血干细胞移植)。诱导治疗均采取以地西他滨为主的化疗方案,包括地西他滨单药(DAC)、地西他滨联合半量CAG方案(DAC-CAG)及地西他滨联合HAAG方案(DAC-HAAG)。在强化治疗方面对大部分患者继续应用原诱导方案治疗,部分患者给予标准"3+7"方案及中大剂量阿糖胞苷治疗。患者缓解后疗程数为2-4周期。结果:49例患者全部完成诱导治疗,完全缓解(CR)26例,部分缓解(PR)7例,无效(NR)16例,CR率53%,总有效率(ORR)67%。DAC组、DAC-CAG组及DAC-HAAG组有效率分别为17%、77%及63%。诱导过程感染14例,死亡1人,死因为肺部感染。诱导过程中平均输注红细胞9 U,输注血小板69U。白细胞恢复时间15 d,血小板恢复时间20 d。患者0.5、1和2年生存率分别为75%、30%及26%,0.5、1及2年无复发生存率分别为83%、54%及47%。诱导治疗是否能达到CR是影响预后的独立因素,而初诊时外周血白细胞和血小板数、年龄、诱导治疗效果、预后分层、化疗方案及诱导时是否合并肺炎均为非独立预后因素。结论:地西他滨联合化疗方案诱导效果优于单药,首次诱导治疗结果是独立的预后因素,而初诊时高白细胞、不良核型、合并症、伴有病态造血相关改变并不影响长期生存。DAC-CAG方案治疗有效率高,不良反应相对较少,适合应用于年龄大、合并症多、不适合常规方案化疗的中老年急性髓系白血病患者。Objective： To investigate the safety and efficacy of decitabine combined with CAGregimen in the treatment of newly diagnosed elderly patients with acute myeloid leukemia（ AML）.Methods： Fourty-nine patients with newly diagnosed acute myeloid leukemia（ except M3） who were admitted to our hospital were selected.All the patients were older than 50 years old,and allogeneic hematopoietic stem cell transplantation could not be performed for various reasons.Decitabine-based chemotherapy regimens were used during induction therapy including single decitabine therapy（DAC）,decitabine combined with CAGregimen（DAC-CAG） and decitabine combined with HAAGregimen（DAC-HAAG）.Most of patients continued to use the original treatment after complete remission,while others were given the standard ＂ 3 ＋ 7＂ regimen chemotherapy.A total of 2-4 courses of treatment was conducted in the majority of patients.Results： All of the 49 patients completed the induction therapy,in which 26 cases achieved complete remission（ CR）,7 cases achieved partial remission（ PR） and no response（ NR） existed in 16 cases.The complete remission and the overall response rate（ ORR） were 53% and 67% respectively.The overall response rate of DAC group,DAC-CAG group and DAC-HAAG group were 17%,77% and 63% respectively.14 patients were infected and 1 patients died of pulmonary infection during the induction therapy.The median number of suspended red blood cells and platelet infused were 9 units and 69 units respectively.Neutrophil recovery time was 15.1 days while the platelet recovery time was 20.1 days during the induction therapy.The mean follow-up time was 21 months.Overall survival（ OS） was 75% at 6 months,30% at 1 year,and 26% at 2 year,while disease-free survival（ DFS） was 83% at 3 months,54% at 1 year,and 47% at 2 year.The induction therapy could reach CR that was an independent prognostic factor,however,the initial white blood cell count,platelet count,age,chemotherapy regimen,prognostic stratification and

关 键 词：急性髓系白血病 地西他滨 CAG方案 诱导治疗 

分 类 号：R733.71[医药卫生—肿瘤]