地西他滨为基础的化疗方案治疗难治性贫血伴原始细胞增多的最佳疗效及预后因素分析  

Analysis on clinical efficacy and influencing factors of decitabine-based regimens in patients with my-elodysplastic syndrome-refractory anemia with excess blasts

作　　者：马家乐 王炎 向立丽[1] 王鲁群[2] 付杰[1] 张璞[1] 李晓林[1] Ma Jiale;Wang Yan;Xiang Lili;Wang Luqun;Fu Jie;Zhang Pu;Li Xiaolin(Department of Hematology,Xuzhou Central Hospital,Xuzhou 221000,China;Department of Hematology,Qilu Hospital of Shandong University,Jinan 250012,China)

机构地区：[1]江苏省徐州市中心医院血液科,221000 [2]山东大学齐鲁医院血液科,济南250012

出　　处：《中国医师杂志》2020年第2期258-262,共5页Journal of Chinese Physician

摘　　要：目的分析地西他滨(DAC)为基础的化疗方案治疗骨髓增生异常综合征-难治性贫血伴原始细胞增多(MDS-RAEB)患者的临床疗效、安全性及预后影响因素。方法回顾性分析63例DAC治疗MDS-RAEB患者的临床资料,评价临床疗效及不良反应,并分析影响生存的相关因素。结果63例患者中RAEB-1 23例,RAEB-2 40例。治疗2~13个疗程(中位4),DAC治疗MDS-RAEB总有效率为58. 7%(37/63),完全缓解率20. 6%(13/63),37例治疗有效患者中,20例(54. 1%)患者2个疗程后开始起效,达最佳疗效的疗程3~4个疗程(中位3. 5)。随访2~68个月(中位14),63例患者1年总生存(OS)率为84. 2%,1年无进展生存(PFS)率为73%。单因素分析中,延长OS的因素为用药后最佳疗效在疾病稳定(SD)以上(达到完全缓解、部分缓解、骨髓完全缓解、血液学改善)(P=0. 009)和初诊时无血小板减少(P=0. 019),延长PFS的因素为最佳疗效在SD以上(P=0. 003)。多因素分析提示,影响OS及PFS的因素均为最佳疗效在SD以上(P=0. 015;P=0. 008)。地西他滨治疗MDS-RAEB的不良反应以骨髓抑制和肺部感染为主。结论地西他滨治疗MDSRAEB安全有效;对地西他滨治疗反应是影响预后的独立因素之一。Objective To analyze the clinical efficacy,safety and influencing factors of decitabine(DAC)-based regimens in patients with myelodysplastic syndrome-refractory anemia with excess blasts(MDS-RAEB).Methods We performed a retrospective analysis of 63 patients with MDS-RAEB treated with DAC,evaluated the clinical efficacy and adverse reactions,and analyzed the influencing factors affecting survival.Results Among 63 patients,23 were RAEB-1 and 40 were RAEB-2.The median treatment was 4(2-13)courses.The total effective rate of DAC for MDS-RAEB was 58.7%(37/63),and the complete response rate was 20.6%(13/63).Among 37 patients who were effective,20(54.1%)patients performed efficacy after 2 courses.The median course of treatment to achieve the best effect was 3.5(3-4)courses.With a median follow-up of 14(2-68)months,63 patients had a overall survival rate(OS)of 84.2%and a I-year progression-free survival rate(PFS)of 73%.In univariate analysis,the factors that prolonged OS were that the best effect after medication was stable disease(SD)(to achieve complete remission,partial remission,complete bone maiTOW remission,hematological improvement)(P=0.009)and no thrombocytopenia at first diagnosis(P=0.019),the factor that prolongs PFS is the best effect above SD(P=0.003).Multivariate analysis suggested that the factors affecting OS and PFS were the best curative effects above SD(P=0.015 vs P=0.008).The adverse effects of decitabine in the treatment of MDS-RAEB were mainly bone manow suppression and pulmonary infection.Conclusions Decitabine is an effective and well-tolerated drug in the treatment of MDS-RAEB.Response to decitabine treatment is one of the independent factors affecting the prognosis.

关 键 词：贫血 难治性 胚细胞生长过多性 药物疗法 联合 地西他滨 预后 因素分析 统计学 

分 类 号：R556[医药卫生—血液循环系统疾病]