两种预激化疗方案治疗MDS-RAEB患者的临床疗效对比研究  

Comparation of Clinical Efficacy between Two Regimens of Preexcitation Chemotherapy for MDS-RAEB Patients

作　　者：潘鹏吉[1] 罗章琴[1] PAN Peng-Ji;LUO Zhang-Qin(Department of Hematology,Yongchuan Hospital of Chongqing Medical University,Chongqing,402160,China)

机构地区：[1]重庆医科大学附属永川医院血液科,重庆402160

出　　处：《中国实验血液学杂志》2019年第2期515-519,共5页Journal of Experimental Hematology

摘　　要：目的:探讨地西他滨(DAC)和CAG/HAG预激化疗方案治疗骨髓增生异常综合征(MDS)难治性贫血合并原始细胞增多(RAEB)的疗效及其安全性的差异。方法:回顾性分析本院2014年2月-2018年2月收治MDS-RAEB患者共86例临床资料。在86例中41例采用DAC方案,设为A组,而其余45例采用CAG/HAG方案,设为B组;比较2组的疾病控制效果、起效疗程、中位生存时间及不良反应的发生率。结果:2组患者CR率和ORR率比较差异无显著性(P>0.05);A组mCR率显著高于B组(P<0.05);A组第2、3疗程显效病例数显著多于B组,但第1疗程显效的病例数在B组多于A组(P<0.05);2组患者中位OS比较差异无显著性(P>0.05);A组粒细胞缺乏持续时间显著短于B组(P<0.05);A组红细胞和血小板输注量均显著少于B组(P<0.05);A组不同疗程时3-4级中性粒细胞缺乏、贫血及血小板减少发生率均显著低于B组(P<0.05);A组第3疗程时3-4级感染发生率显著低于B组(P<0.05)。结论:DAC和CAG/HAG预激化疗方案用于MDS难治性贫血合并RAEB患者的总体病情控制效果接近,但DAC方案能使不良反应的风险更低,而CAG/HAG方案起效更快。Objective:To investigate the efficacy and safely of DAC and CAG/HAG preexcitation chemotherapy regimens for the treatment of patients with MDS-RAEB(refractory anemia with excess blasts,RAEB).Methods:The clinical data of 86 MDS-RAEB patients were analyzed retrospectively from February 2014 to February 2018.According to therapeutic regimem,the 86 patients were divided into 2 groups:group A(41 patients)with DAC preexcitation chemotherapy regimen,and group B(45 patients)with CAG/HAG preexcitation chemotherapy regimen;and the disease control effect,effective treatment course,median survival time and incidence of adverse reactions were compared between these 2 groups.Results:The CR rate and ORR rate were not significantly different between these 2 groups(P>0.05).The mCR rate in group A was significantly higher than that in group B(P<0.05).The numbers of cases obtained therapeutic efficacy at 2 rd and 3 rd conrse in group A significantly more than those in group B(P<0.05),but the number of cases obtained efficacy at 1 st course in group B was significantly higher than that in group A(P<0.05).The median OS time was not significanly different between 2 groups(P>0.05).The duration of neutrophils deficiency in group A was significantly shorter than that in group B(P<0.05).The transfusion volume of red blood cells and platelets in group A was significantly less than that of group B(P<0.05).The incidence of neutropenia,anemia and thrombocytopenia of Ⅲ-Ⅳ grade at different treatment courses of group A were significantly lower than that in group B(P<0.05).The incidence of infection of Ⅲ-Ⅳ grade in group A at 3 rd treatment course was significantly lower than that in group B(P<0.05).Conclusion:Preexcitation chemotherapy regimens of DAC and CAG/HAG for the treatment of MDS-RAEB possess the same effects for disease control;application of DAC regimen can efficiently reduce the risk of adverse reaction,but CAG/HAG regimen can be helpful to accelerate the effective process of treatment.

关 键 词：骨髓增生异常综合征 难治性贫血 原始细胞增多 地西他滨 

分 类 号：R551.3[医药卫生—血液循环系统疾病] B457.7[医药卫生—内科学]