老年急性髓细胞白血病突变基因类型及不同剂量地西他滨联合化疗的临床疗效  

Mutant Gene Types of Elderly Acute Myeloid Leukemia and Clinical Efficacy of Different Doses of Decitabine Com⁃bined with Chemotherapy

作　　者：李正发[1] 毛瑞娇 陆杨柳 胡芃[1] 刘伟 顾世安 冯嘉昆 杨艳梅[1] 赵婕 王启 杨同华[1] Li Zheng-fa;Mao Rui-jiao;Lu Yang-liu;Hu Peng;Liu Wei;Gu Shi-an;Feng Jia-kun;Yang Yanmei;Zhao Jie;Wang Qi;Yang Tong-hua(Department of Hematology,The First People's Hospital of Yunnan Province,Kunming 650032,Yunnan Province,China;School of Medicine,Kunming University of Science and Technology,Kunming 650034,Yunnan Province,China;Yunnan University of Chinese Medicine,Kunming 650032,Yunnan Province,China)

机构地区：[1]云南省第一人民医院血液科,云南昆明650032 [2]昆明理工大学医学院,云南昆明650034 [3]云南中医药大学,云南昆明650032

出　　处：《中外医药研究》2022年第6期30-32,共3页JOURNAL OF CHINESE AND FOREIGN MEDICINE AND PHARMACY RESEARCH

基　　金：云南省临床医学中心专项(编号:2019LCZXKF-XY01);云南省万人计划“名医”专项(编号:YNWR-MY-2019-023);昆明市卫生技术中心专项[编号:2020-SW(技)-32]。

摘　　要：目的:探讨老年急性髓细胞白血病(Elderly-AML)突变基因类型及采用不同剂量地西他滨(DAC)联合化疗的临床疗效。方法:选取2019年5月-2022年3月云南省第一人民医院血液内科收治的Elderly-AML 49例为研究对象,随机分组为研究组1[(DAC 20 mg/(m^(2)·d)]17例,研究组2[(DAC 20 mg/(m^(2)·d)]联合CAG/HAG化疗方案)16例,研究组3[(DAC 15 mg/(m^(2)·d)]联合CAG/HAG化疗方案)16例。通过染色体分析、基因突变、实施不同的治疗方案,比较突变基因表达类型,完成化疗疗程及总有效率,完成化疗疗程人数构成比。结果:49例Elder-AML患者中,共检测到基因突变10(20.41%)例,基因突变类型23种,前5位基因FLT3、TET2、CEBPA、NPM1、RUNX1。基因阳性率表达性占比:2.50%~12.50%。49例患者中,完成2个疗程治疗46(93.9%)例,总有效率50%。完成4个疗程治疗36(73.5%)例,总有效率83.3%。结论:3种不同剂量地西他滨组合方案均可用于Elderly-AML患者。根据Elderly-AML患者体能状况评分系统选择个体化治疗更为重要。Objective:To investigate the mutant gene types of elderly acute myeloid leukemia(Elderly-AML)and clinical efficacy of different doses of decitabine(DAC)combined with chemotherapy.Methods:Forty-nine Elderly-AML patients who were admitted to the Department of Hematology,the First People's Hospital of Yunnan Province from May 2019 to March 2022 were selected as the research objects,and the patients were randomly divided into the research 1 group[DAC 20 mg/(m^(2)·d),n=17],the research 2 group[DAC 20 mg/(m^(2)·d)combined with CAG/HAG chemotherapy regimen,n=16],and the research 3 group[DAC 15 mg/(m^(2)·d)combined with CAG/HAG chemotherapy regimen,n=16].Through chromosome analysis,gene mutation and the implementation of different treatment plans,the mutant gene expression type,the chemotherapy course completed and the total effective rate,as well as the composition ratio of the number of people who completed chemotherapy course were compared.Results:Among 49 Elder-AML patients,10(20.41%)cases were detected with gene mutation,with 23 types of gene mutation,and the top 5 genes were FLT3,TET2,CEBPA,NPM1 and RUNX1.The proportion of positive gene expression was 2.50%-12.50%.Among the 49 patients,46(93.9%)cases completed 2 courses of treatment,with a total effective rate of 50%,36(73.5%)cases completed 4 courses of treatment,with a total effective rate of 83.3%.Conclusion:Three DAC combination regimens at different doses can be used in the treatment of Elderly-AML patients.It is more important to select individualized treatment according to the Elderly-AML patient physical condition scoring system.

关 键 词：老年急性髓细胞白血病 基因突变 地西他滨 化疗方案 

分 类 号：R73[医药卫生—肿瘤]