地西他滨联合非血缘脐血移植治疗缓解后老年急性髓系白血病的疗效和安全性  

Efficacy and safety of decitabine combined with unrelated umbilical cord blood transplantation in the elderly patients with acute myeloid leukemia after achieving remission

作　　者：陈璨 黄永芬 王玲玲 马亚男 程月新 徐浩 陶善东[3] 苗雨青 CHEN Can;HUANG Yong-fen;WANG Ling-ling;MA Ya-nan;CHENG Yue-xin;XU Hao;TAO Shan-dong;MIAO Yu-qing(Yancheng Clinical College of Xuzhou Medical University,Yancheng 224006,Jiangsu,China;Department of Hematology,Yancheng First People’s Hospital,Yancheng 224006,Jiangsu,China;Department of Hematology,Huai’an First Hospital Affiliated to Nanjing Medical University,Huai’an 223300,Jiangsu,China)

机构地区：[1]徐州医科大学盐城临床学院,盐城224006 [2]盐城市第一人民医院血液科,盐城224006 [3]南京医科大学附属淮安第一医院血液科,淮安223300

出　　处：《中国临床医学》2023年第6期981-987,共7页Chinese Journal of Clinical Medicine

基　　金：盐城市医学科技发展计划项目(YK2020004、YK2020014).

摘　　要：目的分析老年急性髓系白血病(AML)患者经诱导治疗达到完全缓解后,用地西他滨联合非血缘脐血移植巩固治疗的疗效和安全性。方法回顾性分析2019年1月至2022年1月至盐城市第一人民医院和南京医科大学附属淮安第一医院血液科就诊的经1~2周期诱导治疗获得完全缓解(CR)的老年AML患者52例,根据巩固治疗方案分为观察组(n=24)和对照组(n=28)。观察组接受地西他滨联合非血缘脐血移植巩固治疗;对照组接受传统巩固治疗,包括阿扎胞苷+维奈克拉、去甲氧柔红霉素+阿糖胞苷或阿柔比星+阿糖胞苷+粒细胞集落刺激因子等。对比两组患者的造血恢复时间、不良反应、无复发生存期(RFS)、总生存期(OS)。结果观察组中性粒细胞中位恢复时间为12.54 d、对照组为18.64 d(P<0.001);观察组血小板中位恢复时间为12.67 d,对照组为19.71 d(P<0.001)。观察组Ⅲ~Ⅳ级骨髓抑制及非血液学毒性发生率差异均无统计学意义。观察组和对照组中位OS分别为36、24个月,中位RFS分别为33、11个月,差异均有统计学意义(P<0.05)。结论相较于传统巩固治疗方案,地西他滨联合非血缘脐血移植巩固治疗诱导缓解后老年AML患者更有效,延长患者生存时间;安全性与传统方案相似。Objective To compare the safety and efficacy of decitabine combined with unrelated umbilical cord blood transplantation and traditional regimen in the elderly patients with acute myeloid leukemia(AML)after achieving complete remission with induction therapy.Methods Fifty-two elderly AML patients who obtained complete remission(CR)after 1-2 cycles of induction therapy in the Department of Hematology of Yancheng First People’s Hospital and the Huai’an First Hospital Affiliated to Nanjing Medical University from January 2019 to January 2022 were enrolled,and were divided into the observation group(n=24)and the control group(n=28).The observation group received decitabine combined with unrelated umbilical cord blood transplantation,and the control group received traditional consolidation therapy,including azacitidine+vinblastine,idarubicin+cytarabine(IA),or aclarubicin+cytarabine+granulocyte colony-stimulating factor,and so on.The hematopoietic recovery time,adverse reactions,relapse-free survival(RFS),and overall survival(OS)were compared between the two groups.Results The median recovery time of neutrophils was 12.54 d in the observation group and wes 18.64 d in the control group(P<0.001);the median recovery time of platelets was 12.67 d in the observation group and was 19.71 d in the control group(P<0.001).There was no difference in incidences of gradeⅢ-Ⅳmyelosuppression and non-hematological toxicity between the two groups.There were statistical differences in the median RFS(33 months vs 11 months)and OS(36 months vs 24 months)between the observation group and the control group(P<0.05).Conclusions Compared with the traditional consolidation regimen,decitabine combined with unrelated umbilical cord blood transplantation for consolidation of AML after achieving remission is more effective in elderly patients,could prolong survival,and has similar safety.

关 键 词：非血缘脐血移植 巩固治疗 老年 急性髓系白血病 疗效 安全性 

分 类 号：R733.71[医药卫生—肿瘤]