地西他滨单用/联合方案治疗101例复发/难治性急性髓细胞白血病患者的临床疗效分析  

Clinical therapeutic efficacy of decitabine contained chemotherapies on 101 patients with relapsed or refractory acute myeloid leukemia

作　　者：张楠晨 王慧芳 吴霞[1] 邓吉利 龚玉萍[1] ZHANG Nanchen;WANG Huifang;WU Xia;DENG Jili;GONG Yuping(Department of Hematology,West China Hospital,Sichuan University,Chengdu,Sichuan 610041,P.R.China)

机构地区：[1]四川大学华西医院血液内科,成都610041

出　　处：《华西医学》2019年第4期363-369,共7页West China Medical Journal

基　　金：四川省科技厅科技计划项目(2015SZ0234);成都市科技局科技惠民计划项目-科技惠民应用示范项目(2016-HM02-00001-SF)

摘　　要：目的分析地西他滨联合化学治疗(化疗)方案治疗复发/难治性急性髓细胞白血病(acute myeloid leukemia,AML)患者的疗效。方法回顾性收集2014年5月—2017年12月复发、难治性AML患者资料,纳入使用数量较多的3种方案:地西他滨单用(DAC方案)15例、地西他滨联合阿糖胞苷+蒽环类抗生素方案及类似方案(D-DA方案)37例和地西他滨联合阿柔比星、阿糖胞苷及粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)方案(D-CAG方案)49例,进行缓解率、血制品支持治疗、骨髓抑制程度、不良反应、生存时间的比较。结果 DAC方案、D-DA方案和D-CAG方案完全缓解率分别为40.0%、48.6%、71.4%,总反应率分别为46.7%、54.1%、79.6%,D-CAG化疗方案总反应率较高(P<0.017)。D-CAG方案组使用G-CSF总量低于DAC方案组[(1 363.0±1 037.9)vs.(2 517.0±1 163.4)μg,P<0.05];D-CAG方案组红细胞悬液输注量及使用G-CSF总量较D-DA方案组少[(6.7±4.0)vs.(14.8±10.1)U,P<0.05;(1 363.0±1 037.9)vs.(2 786.0±1 474.0)μg,P<0.05]。D-CAG方案组血红蛋白、血小板到达低谷期时间较D-DA方案组晚[(11.5±2.6)vs.(8.8±2.5) d,P=0.007;(10.9±2.6)vs.(7.6±2.5)d,P=0.002],血小板到达低谷期时间比DAC方案组晚[(10.9±2.6)vs.(7.6±1.6)d,P=0.003]。3组方案化疗后不良反应发生率差异无统计学意义(P>0.05)。D-CAG方案组中位生存时间较DAC方案组长(11.6 vs.8.8个月,P=0.013)。结论比较3种包含地西他滨的化疗方案发现,使用D-CAG方案治疗复发/难治性AML患者的完全缓解率和总反应率较高,耐受性较好,可尝试在有条件的医疗机构进一步推广。Objective To analyze the clinical efficacy of decitabine contained chemotherapy regimens in the treatment of relapsed or refractory acute myeloid leukemia(AML)patients.Methods A total of 101 patients with relapsed or refractory AML from May 2014 to December 2017 were collected retrospectively.Three schemes with a relatively larger number of users were included:15 cases were treated with decitabine monotherapy(DAC regime);37 cases were treated with decitabine,anthracycline antibiotic,and cytarabine(D-DA regime);and 49 cases were treated with decitabine,cytarabine,aclarubicin,and granulocyte colony-stimulating factor(G-CSF)(D-CAG regimen).The remission rate,blood products support strength,degree and duration of bone marrow suppression,adverse reaction,and survival time were compared.Results The complete remission(CR)rates of DAC,D-DA and D-CAG regimen group were40.0%,48.6%,and 71.4%,respectively;the overall respond rates(ORR)were 46.7%,54.1%,and 79.6%,respectively.The ORR in D-CAG regimen group was higher than those in the other two groups(P<0.017).The dosage of G-CSF in D-CAG regimen group were lower than those in DAC regimen group[(1 363.0±1 037.9)vs.(2 517.0±1 163.4)μg,P<0.05];the mean number of erythrocyte transfusion and the dosage of G-CSF were lower than those in D-DA regimen group[(6.7±4.0)vs.(14.8±10.1)U,P<0.05;(1 363.0±1 037.9)vs.(2 786.0±1474.0)μg,P<0.05];the time to the suppression of hemoglobin and platelet in D-CAG regimen group were later than those in D-DA regimen group[(11.5±2.6)vs.(8.8±2.5)days,P=0.007;(10.9±2.6)vs.(7.6±2.5)days,P=0.002];the time to the suppression of platelet was later than that in DAC regimen group[(10.9±2.6)vs.(7.6±1.6)days,P=0.003].There was no statistically significant difference in the incidence of adverse reations among the three group(P>0.05).The median overall survival of D-CAG regimen group was longer than that in DAC regimen group(11.6 vs.8.8 months,P=0.013).Conclusion Among the three chemotherapy regimens containing decitabine,the CR and ORR of D-CAG regi

关 键 词：地西他滨 急性髓细胞白血病 完全缓解率 不良反应 

分 类 号：R733.71[医药卫生—肿瘤]