地西他滨联合小剂量阿糖胞苷治疗高危骨髓增生异常综合征临床观察  

Clinical observation of decitabine combined with low-dose cytarabine in treatment of high-risk myelodysplastic syndrome

作　　者：崔玉姣 赵新东 吴少玲[2] 段春英 袁海峰 宋峤 Cui Yujiao;Zhao Xindong;Wu Shaoling;Duan Chunying;Yuan Haifeng;Song Qiao(Department of Clinical Medicine,Medical College of Qingdao University,Qingdao 266071,China;Department of Hematology,the Affiliated Hospital of Qingdao University,Qingdao 266000,China)

机构地区：[1]青岛大学医学部临床医学系,266071 [2]青岛大学附属医院血液科,266000

出　　处：《白血病．淋巴瘤》2020年第5期279-283,共5页Journal of Leukemia & Lymphoma

基　　金：山东省自然科学基金(ZR2019MH096)。

摘　　要：目的观察地西他滨联合小剂量阿糖胞苷治疗高危骨髓增生异常综合征(MDS)的临床效果及安全性。方法回顾性分析2016年1月至2018年9月在青岛大学附属医院治疗的47例修订的国际预后指数评分系统(IPSS-R)评分为高危及以上的初治MDS患者资料,根据是否联合应用阿糖胞苷,分为地西他滨联合小剂量阿糖胞苷组(15例)与地西他滨组(32例),比较两种不同治疗方案的临床疗效及不良反应。结果治疗4个疗程后,地西他滨联合小剂量阿糖胞苷组与地西他滨组骨髓缓解率、部分缓解率、血液学缓解率分别为20.0%(3/15)比28.1%(9/32)、6.7%(1/15)比3.1%(1/32)13.3%(2/15)比9.4%(3/32),两组差异均无统计学意义(均P>0.05),但地西他滨联合小剂量阿糖胞苷组总有效率及完全缓解率均高于地西他滨组,分别为93.3%(14/15)比62.5%(20/32)(P=0.037)、53.3%(8/15)比21.9%(7/32)(P=0.046)。地西他滨联合小剂量阿糖胞苷组1年总生存(OS)率为86%,中位OS时间为24个月(95%CI 15.5~32.5个月),长于地西他滨组(20个月),但差异无统计学意义(χ^2=0.058,P=0.810)。地西他滨联合小剂量阿糖胞苷组Ⅲ~Ⅳ级骨髓抑制及感染的发生率均高于地西他滨组,但两组差异均无统计学意义(均P>0.05),其中地西他滨联合小剂量阿糖胞苷组治疗1~2个疗程时Ⅲ~Ⅳ级骨髓抑制及感染较常见,后续治疗中不良反应逐渐减少。结论地西他滨联合小剂量阿糖胞苷治疗高危及以上的MDS患者可达到更高的缓解率,延长生存时间,Ⅲ~Ⅳ级骨髓抑制及感染无明显增加;对于不适宜或不能行造血干细胞移植的高危MDS患者,可作为优先选择的方案。Objective To observe the clinical efficacy and safety of decitabine combined with low-dose cytarabine in treatment of high-risk myelodysplastic syndrome.Methods The data of 47 newly treated MDS patients who had high-risk or above scores according to revised international prognostic scoring system(IPSS-R)in the Affiliated Hospital of Qingdao University from January 2016 to September 2018 were retrospectively analyzed.The patients were divided into decitabine combined with low-dose cytarabine group(15 cases)and decitabine group(32 cases).The clinical efficacy and adverse reactions in two groups were compared.Results After 4 courses of treatment,the bone marrow remission rate,partial remission rate and hematologic remission rate was 20.0%(3/15),6.7%(1/15),and 13.3%(2/15),respectively in decitabine combined with low-dose cytarabine group,and was 28.1%(9/32),3.1%(1/32),and 9.4%(3/32),respectively in decitabine group,and there were no statistically differences of both groups(both P>0.05).The overall response rate in decitabine combined with low-dose cytarabine group was higher than that in decitabine group[93.3%(14/15)vs.62.5%(20/32),P=0.037],and the complete remission rate in decitabine combined with low-dose cytarabine group was higher than that in decitabine group[53.3%(8/15)vs.21.9%(7/32),P=0.046].The 1-year overall survival(OS)rate of decitabine combined with low-dose cytarabine group was 86%;and the median OS time of decitabine combined with low-dose cytarabine group was 24 months(95%CI 15.5-32.5 months),which was higher than that of decitabine group(20 months),but there was no statistically significant difference(χ^2=0.058,P=0.810).The incidence of gradeⅢ-Ⅳbone marrow suppression and infection in decitabine combined with low-dose cytarabine group was higher than that in decitabine group,but there were no statistically significant differences of both groups(both P>0.05).GradeⅢ-Ⅳbone marrow suppression and infection were commonly found within the first 2 courses of treatment in decitabine combined with lo

关 键 词：骨髓增生异常综合征 药物疗法 联合 地西他滨 阿糖胞苷 去甲基化 

分 类 号：R5[医药卫生—内科学]