WT1基因表达对CAG预激方案联合与不联合地西他滨治疗AML和MDS的疗效预估价值  

Predictive value of WT1 expression to the curative effect on treating acute myeloid leukemia and myelodysplastic syndrome with CAG regimen combined with or without decitabine.

作　　者：刘军民 罗伟 孙洪波 李泉洪 张宏宇[3] 杜新[4] LIU Jun-min;LUO Wei;SUN Hong-bo;LI Quan-hong;ZHANG Hong-yu;DU Xin(Department of Hematology,People′s Hospital of Longhua district,Shenz-hen 518019,Guangdong,China;不详)

机构地区：[1]深圳市龙华区人民医院血液科,广东深圳518109 [2]深圳市坪山区人民医院内二科,广东深圳518118 [3]北京大学深圳医院血液科,广东深圳518036 [4]深圳市第二人民医院血液科,广东深圳518028

出　　处：《广东医学》2020年第16期1664-1668,共5页Guangdong Medical Journal

基　　金：深圳市科技计划项目(JCYJ20180228164237514)。

摘　　要：目的观察WT1基因表达对CAG预激方案联合或不联合地西他滨(DAC)治疗急性髓系白血病(AML)和骨髓增生异常综合征(MDS)的疗效影响,探讨其对疗效预估和治疗策略的价值.方法回顾性分析在深圳市3家医院接受CAG预激方案联合和不联合DAC治疗的87例AML及MDS患者,根据治疗前WT1基因表达及治疗方案分为4组:WT1高表达/CAG组、WT1高表达/D-CAG组、WT1低表达/CAG组和WT1低表达/D-CAG组.分析各组经1~2个诱导疗程后的疗效[完全缓解(CR)率、总有效率(ORR)]和不良反应(Ⅳ度骨髓抑制发生率、中性粒细胞缺乏时间和血小板低下时间).结果与WT1高表达/CAG组比较,WT1低表达/CAG组CR率和ORR率均更高(P<0.05),WT1高表达/D-CAG组CR率和ORR率亦均更高(P<0.05),但WT1高表达/D-CAG组Ⅳ度骨髓抑制发生率相对更高(P<0.05),粒缺持续时间和血小板低下时间相对更长(P<0.05).与WT1低表达/CAG组比较,WT1低表达/D-CAG组CR率和ORR率差异无统计学意义(P>0.05),而Ⅳ度骨髓抑制发生率更高(P<0.05),血小板低下时间均更长(P<0.05).结论WT1高表达AML或MDS患者接受CAG方案诱导化疗的疗效较WT1低表达患者差,联合DAC可增加疗效,但不良反应加重.WT1低表达AML或MDS患者,CAG预激方案诱导疗效相对较好,联合DAC并不改善疗效,而不良反应加重.Objective To observe the inflence of WT1 gene expression on the curative effect of CAG regimen combined with or without decitabine in treating acute myeloid leukemia(AML)and myelodysplastic syndrome(MDS),and to investigate its value to the efficacy prediction and therapeutic strategy.Methods The medical records of 87 pa-tients with AML or MDS,who underwent CAG regimen therapy with or without decitabine in three hospitals of Shenzhen were retrospectively analyzed.According to the expression of WT1 gene before treatment and therapeutic regimen,the pro-tocol was divided into 4 groups,WT1 high expression/CAG group,WT1 high expression/D-CAG group,WT1 low ex-pression/CAG group and WT1 low expression/D-CAG group.The curative effect,including complete remission(CR)rate and overall response rate(ORR),and adverse reactions(Ⅳdegree of myelosuppression,granulocytopenia,and thrombocytopenia)after 1 to 2 treatments were analyzed.Results Compared with WT1 high expression/CAG group,the patients in WT1 low expression/CAG group had significantly higher CR rate and ORR(P<0.05).The Patients in WT1 high expression/D-CAG group had also significantly higher CR rate and ORR(P<0.05),but significantly higher oc-currence ofⅣdegree myelosuppression and longer duration of granulocytopenia and thrombocytopenia(P<0.05)than those in WT1 high expression/CAG group.There was no significant difference in CR rate or ORR between WT1 low ex-pression/D-CAG group and WT1 low expression/CAG group(P<0.05).Compared with WT1 low expression/CAG group,the patients in WT1 low expression/CAG group had significantly higher occurrence of IV degree myelosuppression and longer duration of thrombocytopenia(P<0.05).Conclusion The patients with AML or MDS highly expressing WT1 gene have worse curative effect than those lowly expressing WT1 gene treated with CAG regimen;while combining with DAC can improve the curative effect,but also aggravates the adverse reactions.Combining with DAC for the patients with AML or MDS lowly expressing WT1 gene does not improve cura

关 键 词：WT1基因 急性髓系白血病 骨髓增生异常综合征 CAG预激方案 地西他滨 

分 类 号：R733.71[医药卫生—肿瘤] R730.53[医药卫生—临床医学]