地西他滨联合预激方案治疗首疗程标准诱导化疗失败急性髓系白血病疗效及安全性分析  

Efficacy and safety of re⁃induction regimen of decitabine combined with CAG in treatment of acute myeloid leukemia after failed standard induction chemotherapy in the first course

作　　者：陈依丽 赵文舒 郭绪涛[1] 赵珂[1] 张钰[1] 刘启发[1] 戴敏[1] CHEN Yili;ZHAO Wenshu;GUO Xutao;ZHAO Ke;ZHANG Yu;LIU Qifa;DAI Min(Department of Hematology,Nanfang Hospital,Southern Medical University,Guangzhou 510515,China)

机构地区：[1]南方医科大学南方医院血液内科,广州510515

出　　处：《实用医学杂志》2021年第14期1800-1804,共5页The Journal of Practical Medicine

基　　金：国家自然科学基金(编号:81500149)。

摘　　要：目的探讨地西他滨(DAC)联合CAG预激方案治疗首疗程标准诱导化疗失败急性髓性白血病(acute myeloid leukemia,AML)患者的疗效及安全性。方法选取首疗程标准诱导化疗失败AML患者84例,按照再诱导治疗方案的不同分为DAC+预激方案(即DCAG)组、IA3+7组及中剂量阿糖胞苷(IDCB)组,再诱导治疗后,比较3组临床疗效及不良反应。结果3组间完全缓解(CR)率差异无统计学意义(P=0.091),DCAG组OR(CR+PR)率高于IDCB组(P=0.049)。DCAG组PLT<20 G/L时间短于IA3+7组及IDCB组(P=0.001、0.023)。3组中性粒细胞缺乏中位持续时间差异无统计学意义(P=0.061)。DCAG组肺部感染发生率、中性粒细胞缺乏伴发热发生率低于IA3+7组(P=0.018、0.004),与IDCB组相比差异无统计学意义。DCAG组、IA3+7组、IDCB组患者2年OR率分别为69.4%、43.8%、33.2%,2年无复发生存(RFS)率分别为70.6%、50.3%、41.4%。DCAG组2年OS和RFS均显著长于IA3+7组及IDCB组,差异有统计学意义(OS:P=0.038、0.023;RFS:P=0.048、0.016)。结论地西他滨联合预激方案治疗首疗程标准诱导化疗失败AML患者,能获得较好的总反应率及安全性,延长患者生存时间。Objective To explore the efficacy and safety of re⁃induction regimen of decitabine in combination with CAG for patients with acute myeloid leukemia after failed standard induction chemotherapy in the first course.Methods Eighty⁃four patients with failed standard induction chemotherapy in the first course included in the study were divided equally into three groups:DCAG,IA3+7,and IDCB,treated with the regimens of DAC combined with CAG,IA(3+7)and Intermediate⁃dose Ara⁃C⁃based chemotherapy(IDCB)including IA3+3 and CLAG,respectively.After re⁃induction therapy,the clinical efficacy and adverse reactions were compared among the 3 groups.Results No significant difference in the complete remission(CR)was found between the three groups(P=0.091),but the rates of overall response(OR)(complete remission(CR)and partial remission(PR))in the DCAG group was significantly higher than the IDCB group(P=0.049).The median duration of thrombocytopenia in the DCAG group was significantly shorter than IA3+7 and IDCB groups(P=0.001;P=0.023).No significant difference in the median time of neutropenia was found among the 3 groups(P=0.061).The incidence rates of lung infection and febrile neutropenia in the DCAG group were significantly lower than the IA3+7 group(P=0.018;P=0.004).The 2⁃year OS of the DCAG,IA3+7 and IDCB groups was 69.4%,43.8%and 33.2%,respectively,and the 2⁃year RFS was 70.6%,50.3%and 41.4%,respectively.The OS and RFS of DCAG were significantly longer than the IA3+7 and IDCB groups(P=0.038 and P=0.023 for OS;P=0.016 and P=0.048 for RFS).Conclusions DCAG regimen may represent a better alternative option with good response and safety for AML patients failing in the first course of standard induction chemotherapy.

关 键 词：急性髓系白血病 再诱导治疗 疗效 安全性 

分 类 号：R551.3[医药卫生—血液循环系统疾病]