2种方案对复发难治性急性髓系白血病的疗效及其对免疫功能的影响  

Effects of 2 therapeutic regimes on the efficacy and immune function in patients with relapsed and refractory acute myeloid leukemia

作　　者：张娟[1] 郑雯琦[1] 柴俊月[1] 崔婷婷[1] 魏娜[1] 龚颉 ZHANG Juan;ZHENG Wenqi;CHAI Junyue;CUI Tingting;WEI Na;GONG Jie(Department of Hematology,Beijing Sixth Hospital,Beijing 100007,China)

机构地区：[1]北京市第六医院血液科,北京100007

出　　处：《西北药学杂志》2023年第6期152-157,共6页Northwest Pharmaceutical Journal

基　　金：北京市东城区卫生科技计划项目(编号:东卫健研[2021]-2)。

摘　　要：目的观察2种治疗方案对复发难治性急性髓系白血病(acute myelocytic leukemia,AML)的疗效及其对患者免疫功能和不良反应的影响。方法回顾性分析66例AML患者的临床资料,按治疗方案不同分为VEN组(30例)和CAG组(36例)。VEN组给予维奈托克联合阿扎胞苷治疗,CAG组给予阿扎胞苷联合CAG方案(阿柔比星、粒细胞集落刺激因子、阿糖胞苷)治疗。比较2组的疗效;比较2组治疗前及治疗4周后血红蛋白(hemoglobin,Hb)、血小板计数(platelets,PLT)、骨髓原始细胞百分比、肿瘤标志物和免疫功能;比较2组不良反应、1年生存率及无病生存率。结果治疗4周后,VEN组的总缓解率(66.67%)显著高于CAG组(41.67%),P<0.05,2组的Hb和PLT均升高(P<0.05),骨髓原始细胞百分比均降低(P<0.05),且与CAG组比较VEN组的上述指标更佳(P<0.05);2组的LDH和TSGF均降低(P<0.05),肿瘤坏死因子-α(tumor necrosis factor-α,TNF-α)较治疗前升高(P<0.05);2组CD3+、CD4+及CD4+/CD8+值均升高(P<0.05),且VEN组显著高于CAG组(P<0.05);VEN组肝肾功能异常、骨髓抑制和恶心呕吐的发生率显著低于CAG组(P<0.05),其他不良反应2组比较差异无统计学意义(P>0.05);2组1年总生存率比较差异无统计学意义(P>0.05);VEN组的无病生存率(40.00%)显著高于CAG组(16.67%),P<0.05;VEN组的总生存期[(10.05±1.48)个月]与无病生存期[(9.22±1.08)个月]均显著高于CAG组(P<0.05)。结论VEN联合阿扎胞苷和CAG联合阿扎胞苷在治疗复发难治性AML中均具有良好的疗效,VEN联合阿扎胞苷的疗效更好,能够改善患者的免疫功能,并且减少不良反应,患者的预后更佳。Objective To observe the effects of 2 therapeutic regimes on efficacy,immune function and adverse reactions in patients with relapsed and refractory acute myeloid leukemia(AML).Methods The clinical data of 66 AML patients in recent 3 years were retrospectively analyzed.The patients were divided into 2 groups according to different therapeutic regimes,30 cases in VEN group and 36 cases in CAG group.The patients in VEN group were given venetoclax and azacytidine,while the patients in CAG group were given azacitidine and CAG regime(aclarubicin,granulocyte colony stimulating factor and cytarabine).The efficacy,hemoglobin(Hb),platelet count(PLT),percentage of bone marrow blast cells,tumor markers,immune function before treatment and after 4 weeks of treatment,toxic and side effects,1-year survival rate and disease-free survival rate were compared between the 2 groups.Results After 4 weeks of treatment,the total remission rate of VEN group was 66.67%,which was significantly higher than 41.67%of CAG group(P<0.05).After 4 weeks of treatment,the Hb and PLT in both groups were enhanced compared with those before treatment(P<0.05),while the percentage of bone marrow blast cells was reduced(P<0.05),and the above indicators were significantly different between VEN group and CAG group after 4 weeks of treatment(P<0.05).The levels of LDH and TSGF in the 2 groups after 4 weeks of treatment were decreased(P<0.05),while the level of TNF-αwas increased compared with before treatment(P<0.05),and there were differences in the above levels between VEN group and CAG group after 4 weeks of treatment(P<0.05).After 4 weeks of treatment,the levels of CD3+,CD4+and CD4+/CD8+were increased compared with before treatment(P<0.05),and the levels in VEN group were significantly higher than those in CAG group(P<0.05).The incidence rates of liver-kidney dysfunction,myelosuppression and nausea and vomiting in VEN group were significantly lower than those in CAG group(P<0.05),but there was no significant difference(P<0.05).There was no statistically

关 键 词：阿扎胞苷 CAG方案 维奈克拉 急性髓系白血病 免疫功能 

分 类 号：R973[医药卫生—药品]