克拉屈滨持续静脉滴注组成的CLAG方案治疗难治/复发性急性髓系白血病的临床分析  

CLAG Regimen Composed of Continuous Intravenous Infusion of Cladribine in the Treatment of Refractory/Relapsed Acute Myeloid Leukemia

作　　者：米瑞华 陈琳 杨海平[2] 王娴静[3] 郭淑利[4] 石琳[5] 尹青松 魏旭东 MI Rui-Hua;CHEN Lin;YANG Hai-Ping;WANG Xian-Jing;GUO Shu-Li;SHI Lin;YIN Qing-Song;WEI Xu-Dong(Henan Cancer Hospital/The Affiliated Tumor Hospital of Zhengzhou University,Zhengzhou 450008,Henna Province,China;Department of Hematology,The First Affiliated Hospital of Henan University of Science and Technology,Luoyang 471000,Henan Province,China;Department of Hematology,The Third People's Hospital of Zhengzhou,Zhengzhou 450000,Henan Province,China;Department of Hematology,Luoyang Central Hospital,Luoyang 471000,Henan Province,China;Department of Hematology,Second Affiliated Hospital of Henan University of Traditional Chinese Medicine,Zhengzhou 450000,Henan Province,China)

机构地区：[1]河南省肿瘤医院/郑州大学附属肿瘤医院,河南郑州450008 [2]河南科技大学第一附属医院血液科,河南洛阳471000 [3]郑州市第三人民医院血液科,河南郑州450000 [4]洛阳市中心医院血液科,河南洛阳471000 [5]河南中医药大学第二附属医院血液科,河南郑州450000

出　　处：《中国实验血液学杂志》2021年第2期333-338,共6页Journal of Experimental Hematology

基　　金：河南省医学科技攻关计划省部共建项目(201701027)。

摘　　要：目的:研究克拉屈滨(2-CdA)持续静脉滴注联合大剂量阿糖胞苷(Ara-C)及粒细胞集落刺激因子(G-CSF)2019年8月在郑州大学附属肿瘤医院血液科等5家医疗单位住院且采用1个疗程CLAG方案(具体为:克拉屈滨5mg/m^(2),d 1-5,持续24 h静脉滴注;Ara-C 2 g/m^(2),1/d,d 1-5,静脉滴注;G-CSF 300 mg,1/d,d 0-5,皮下注射)治疗的岁;FAB分型:M_(1)1例,M_(2)a 3例,M_(2)b 4例(其中1例伴髓外侵犯),M_(4)1例伴髓外侵犯,M_(5)5例,HAL 1例;NCCN分型:中危组6例,高危组9例;难治8例,复发7例。前期中位化疗次数4(2-8)个(其中例15曾接受化疗8周期,并12例(12/15,80%),CR中位持续时间为65(0-528)d。所有患者化疗后均出现IV级白细胞减少及血小板减少,粒缺期中位持续时间为20(14-33)d,治疗相关死亡1例。7例患者接受异基因造血干细胞移植。15例患者的中位无事件复发/难治性AML,CR高,但CR持续时间短,骨髓抑制重。因此,控制感染是关键,CR后应尽早行异基因造血干细胞移植术。Objective:To study the efficacy and safety of continuous intravenous infusion of 2-Chlorodeoxyadenosine(2-CdA)combined with high-dose cytarabine(Ara-C)and granulocyte colony-stimulating factor(G-CSF)(CLAG regiem)in the treatment of relapsed/refractory acute myeloid leukemia(AML).Methods:Fifteen patients with refractory/relapsed AML hospitalized in 5 medical units such as Department of Hematology,the Affiliated Tumor Hospital of Zhengzhou University and received one course of CLAG regimen from June 2014 to August 2019 were analyzed retrospectively(specifically:cladribine 5 mg/m^(2),day 1 to day 5,continuous 24-hour intravenous infusion;Ara-C2 g/m^(2),1 time/day,day 1 to day 5,intravenous infusion;G-CSF 300 mg,1 time/day,day 0 to day 5,subcutaneous injection).Results:Among the 15 patients with refractory/relapsed AML,9 males and 6 females,the median age was 35(13-63)years old.FAB classification:1 case of M_(1),3 cases of M_(2) a,4 cases of M_(2) b(including 1 case with extramedullary invasion),1 case of M_(4) with extramedullary invasion,5 cases of M_(5),1 case of HAL;NCCN classification:6 cases in intermediate risk group,9 cases in high risk group;8 cases refractory,7 cases relapsed.The median time of pre-chemotherapy was4(2-8)(of which NO.15 had received 8 cycles of chemotherapy and received CLL1-CAR-T),and the median white blood cell count before chemotherapy was 12.27(from 0.78 to 5.29)×10^(9)/L.After 1 course of treatment with CLAG regimen,12 patients achieved complete remission(12/15,80%),and the median duration of CR was 65 days(0-528)days.IV grade leukopenia and thrombocytopenia was found in all the patients after chemotherapy.The median duration of granulocytosis was 20(14 to 33)days,and 1 patient died.Seven patients received allogeneic hematopoietic stem cell transplantation.The median EFS and OS time of 15 patients was 85(19-558)days and 117(19-558)days,respectively.Conclusion:The CLAG regimen consisting of continuous intravenous infusion of cladribine shows high CR in the treatment of AML patients,but

关 键 词：CLAG方案 急性髓系白血病 复发 难治 治疗 

分 类 号：R733.71[医药卫生—肿瘤]