低剂量地西他滨联合减量IAG方案治疗老年骨髓增生异常综合征转化的急性髓系白血病疗效观察  

Therapeutic effect of low-dose decitabine combined with IAG regimen in the treatment of elderly myelodysplastic syndrome transformed acute myeloid leukemia

作　　者：高飞[1] 杜明珠[1] 李光[1] 王浩[1] 刘锋[1] 宋艳萍[1] Gao Fei;Du Mingzhu;Li Guang;Wang Hao;Liu Feng;Song Yanping(Xi＇an Central Hospital,Xi＇an Institute of Hematology,Shaanxi Xi＇an 710003,China.)

机构地区：[1]西安市中心医院西安市血液病研究所,陕西西安710003

出　　处：《现代肿瘤医学》2018年第24期4015-4018,共4页Journal of Modern Oncology

基　　金：陕西省自然科学基础研究计划(编号:2013JM4016)

摘　　要：目的:观察低剂量地西他滨联合减量IAG方案(IDA、Ara-C、G-CSF)诱导治疗老年骨髓增生异常综合征(myelodysplastic syndrome,MDS)转化的急性髓系白血病(acute myeloid leukemia,AML)的疗效及安全性。方法:回顾性分析我中心2015年7月至2017年9月收治的53例老年MDS转化的AML患者,采用低剂量地西他滨联合减量IAG方案诱导治疗,观察疗效并评价其安全性。结果:所有53例患者均完成2疗程化疗,骨髓造血恢复后复查骨髓象评估疗效。其中完全缓解(complete remission,CR) 23例(43. 4%),部分缓(partial remission,PR) 11例(20. 8%),总有效率(overall remission rate,ORR) 64. 2%(34/53)。所有患者均出现Ⅲ-Ⅳ级血液学毒性,主要合并症为粒细胞减少所致的感染及血小板减少所致的出血。恶心呕吐、肝肾功损害、心脏毒性等非血液学毒性均可耐受,无治疗相关死亡。性别、年龄、KPS评分对完全缓解率无明确影响,细胞遗传学良好者较细胞遗传学不良者缓解率高,差异有统计学意义(P <0. 05)。结论:低剂量地西他滨联合减剂量IAG方案治疗老年MDS转化的AML疗效确切,缓解率高,不良反应可耐受,临床值得推广。Objective： To observe the efficacy and safety of low-dose decitabine combined with IAG regimen（ IDA,Ara-C,G-CSF） in the treatment of acute myeloid leukemia（ AML） transformed with elderly myelodysplastic syndrome（ MDS）. Methods： We retrospectively analyzed 53 patients with acute myeloid leukemia transformed from myelodysplastic syndrome admitted to our center from July 2015 to September 2017. We used low-dose combination of decitabine and decrement. The IAG regimen induces treatment,observes the efficacy and evaluates its safety. Results： All 53 patients completed 2 course of chemotherapy,and bone marrow hematopoiesis was used to evaluate the efficacy after recovery of bone marrow hematopoiesis. Among them,23 patients（ 43. 4%） had complete remission（ CR）,11（ 20. 8%） had partial remission（ PR）,and 64. 4%（ 23/53） had overall remission rate（ ORR）. All patients had grade Ⅲ-Ⅳ hematologic toxicity. The major complications were granulocytopenia-induced infections and thrombocytopenia-induced hemorrhage. Nausea and vomiting,liver and kidney damage,cardiotoxicity,and other non-hematologic toxicities can be tolerated without treatment-related death. Gender,age,and KPS score had no clear effect on complete remission rate,and those with good cytogenetics had higher remission rates than those with poor cytogenetics. The difference was statistically significant（ P〈0. 05）. Conclusion： Low-dose decitabine combined with reduced-dose IAG regimen is effective for the treatment of elderly MDS-transformed acute myeloid leukemia. The remission rate is high and the adverse reactions are tolerable. The clinical value is worth promoting.

关 键 词：地西他滨 伊达比星 老年患者 骨髓增生异常综合征 急性髓系白血病 疗效 不良反应 

分 类 号：R733[医药卫生—肿瘤]