依托泊苷联合小剂量地西他滨联合CAG方案治疗复发/难治急性髓系白血病的疗效与安全性  

Efficacy and safety of etoposide in combination with low⁃dose of decitabine and CAG regimen for the treatment of relapsed/refractory acute myeloid leukemia

作　　者：李赟 袁国林[2] 程辉[3] 张友山[4] 苏梅芳[5] 杨壮志 陈世明[7] 李登举[1] 张义成[1] Li Yun;Yuan Guolin;Cheng Hui;Zhang Youshan;Su Meifang;Yang Zhuangzhi;Chen Shiming;Li Dengju;Zhang Yicheng(Department of Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院血液科,武汉430030 [2]襄阳市中心医院血液科 [3]武汉市第一医院血液科 [4]荆州市第一人民医院血液科 [5]黄冈市中心医院血液科 [6]湖北医药学院附属随州医院血液科 [7]黄石市中心医院血液科

出　　处：《临床内科杂志》2021年第9期598-602,共5页Journal of Clinical Internal Medicine

基　　金：国家自然科学基金面上项目(81873446)。

摘　　要：目的评价依托泊苷联合小剂量地西他滨联合CAG方案[阿糖胞苷+阿克拉霉素+粒细胞集落刺激因子(G⁃CSF)]治疗复发/难治急性髓细胞白血病(AML)的疗效和安全性。方法回顾性分析来自7家医疗中心共69例患者的病历资料,根据治疗方案分为D⁃CAG组(地西他滨联合CAG方案化疗,44例)和ED⁃CAG组(依托泊苷、地西他滨联合CAG方案化疗,25例)。比较两组患者化疗后的疗效和不良反应。结果两组患者客观缓解(OR)率、完全缓解(CR)率、部分缓解(PR)率、死亡患者比例、中位总生存(OS)期、1年OS率、中位无进展生存(PFS)期、1年PFS率比较差异均无统计学意义;两组不同年龄段CR、OR患者比例及OS期、PFS期组内与组间比较差异均无统计学意义;同一治疗方案下,既往接受化疗次数不同的患者PFS期比较差异无统计学意义;在不同治疗方案下,既往接受化疗次数相近的患者PFS期比较差异无统计学意义(P>0.05)。两组患者的不良反应情况相似(P>0.05)且可控。ED⁃CAG组患者化疗后血常规恢复时间较D⁃CAG组患者更长(P=0.034)。ED⁃CAG组年龄≥60岁患者血常规恢复时间较D⁃CAG组年龄≥60岁患者更长(P=0.024)。结论尽管两组患者的生存率无统计学差异,两种方案均可考虑作为合适患者接受异基因造血干细胞移植前的桥接治疗方案,但ED⁃CAG方案的血液系统毒性相对更重,其相较于D⁃CAG方案的优越性仍需进一步研究。Objective To evaluate the efficacy and safety of etoposide combined with low-dose of decitabine and CAG regimen[cytarabine+aclarubicin+granulocyte colony-stimulating factor(G-CSF)]for the treatment of relapsed/refractory acute myeloid leukemia(AML).Methods The medical records of 69 patients from 7 medical centers were retrospectively analyzed.According to treatment regimen,they were divided into D-CAG group(desicitabine combined with CAG chemotherapy,44 cases)and ED-CAG group(etoposide,desicitabine combined with CAG chemotherapy,25 cases).The efficacy and adverse reactions after chemotherapy were compared between the two groups.Results There were no significant differences in OR rate,CR rate,PR rate,proportion of patients who died,median OS time,1-year OS rate,median PFS time and 1-year PFS rate between the two groups;There was no significant difference in the patients proportion of CR and OR,OS time and PFS time between the two groups at different ages;Under the same treatment plan,there was no statistically significant difference in PFS stage among patients who had received different times of chemotherapy;Under different treatment regiments,there was no statistically significant difference in PFS stage among patients who had received similar times of chemotherapy(P>0.05).Adverse reactions in the two groups were similar(P>0.05)and controllable.The recovery time of blood routine after chemotherapy in ED-CAG group was longer than that in D-CAG group(P=0.034).The recovery time of patients whose age≥60 years old in ED-CAG group was longer than that of patients whose age≥60 years old in D-CAG group(P=0.024).Conclusion Although there is no significant difference in survival rate between the two groups,both 2 regimens could be considered as a bridge therapy for suitable patients before allogeneic hematopoietic stem cell transplantation.However,the blood system toxicity of ED-CAG is relatively more severe,and its superiority over D-CAG still needs further study.

关 键 词：急性髓系白血病 地西他滨 依托泊苷 CAG方案 

分 类 号：R733.71[医药卫生—肿瘤]