去甲基化药物在慢性粒单核细胞白血病中的临床疗效观察  

Clinical Efficacy of Hypomethylating Agent Therapy in Patients with Chronic Myelomonocytic Leukemia

作　　者：李笑 王艳[1] 郭玉洁[1] 牛志云[1] 马莉 周旭泉 张敬宇[1] LI Xiao;WANG Yan;GUO Yu-Jie;NIU Zhi-Yun;MA Li;ZHOU Xu-Quan;ZHANG Jing-Yu(Department of Hematology,The Second Hospital of Hebei Medical University,Hebei Province Blood Disease Primary Laboratory,Shijiazhuang 050000,Hebei Province,China)

机构地区：[1]河北医科大学第二医院血液科,河北省血液病重点实验室,河北石家庄050000

出　　处：《中国实验血液学杂志》2024年第1期257-261,共5页Journal of Experimental Hematology

摘　　要：目的:观察去甲基化药物在慢性粒单核细胞白血病(CMML)中的临床疗效及安全性。方法:回顾性分析2014年2月至2021年6月在河北医科大学第二医院确诊为CMML并应用去甲基化药物治疗的患者的临床资料、疗效指标、生存期及安全性。结果:共有25例CMML患者接受去甲基化药物治疗,18例以地西他滨为基础治疗,7例以阿扎胞苷为基础治疗。其中20例获得应答,7例获得完全缓解(CR),CR患者均以地西他滨为基础治疗,5例CR发生于治疗的前4个疗程。中位随访16.4(9.4-20.5)个月后,4例CR患者进展为急性髓系白血病。25例CMML患者的中位总生存期为17.4个月(95%CI:12.437-22.363)。按照MDAPS、CPSS、CPSS-mol、MMM预后积分系统分别对患者进行危险度分层,仅发现MDAPS预后积分系统不同危险度分层与生存期之间的差异有统计学意义。CMML患者应用去甲基化药物的常见不良反应包括感染、胃肠道反应、血液学毒性、皮肤过敏和肝功能损伤。所有患者给予相应的治疗后,症状均得到改善。结论:去甲基化药物对CMML患者治疗有效,且安全性良好。CR多发生于治疗的前4个疗程,对于无应答的患者,可应用去甲基化药物联合小剂量化疗。去甲基化药物可以延缓病情但并不能阻止CMML的疾病进展。Objective:To observe the clinical efficacy and safety of hypomethylating agent therapy in chronic myelomonocytic leukemia(CMML).Methods:From February 2014 to June 2021,the clinical data,efficacy,survival time and safety of CMML patients diagnosed in the Second Hospital of Hebei Medical University and treated with hypomethylating agent therapy were retrospectively analyzed.Results:A total of 25 CMML patients received hypomethylating agent therapy,including 18 cases treated with decitabine(DEC)and 7 cases treated with azacytidine(AZA)as the basic treatment.Among them,20 patients responded,and 7 patients got complete remission(CR).All patients with CR were treated with DEC as the basic treatment.Five cases of CR occurred in the first 4 courses of treatment.After a median follow-up of 16.4(9.4-20.5)months,4 patients with CR progressed to acute myeloid leukemia(AML).The median overall survival(OS)time of 25 CMML patients was 17.4 months(95%CI:12.437-22.363).According to MD Anderson prognostic scoring system(MDAPS),CMML-specific prognostic scoring system(CPSS),CPSS molecular(CPSS-mol),Mayo molecular model(MMM),risk stratification of patients was performed,and the difference only between different risk stratification of MDAPS and survival time was statistically significant.Common adverse reactions of hypomethylating agent therapy in CMML patients included infection,gastrointestinal reaction,hematological toxicity,skin allergy and liver function damage.All patients′symptoms were improved after corresponding treatment.Conclusion:Hypomethylating agent therapy is effective and safe for CMML patients.CR mostly occurs in the first 4 courses of treatment,and hypomethylating agent therapy combined with low-dose chemotherapy can be used for patients who do not respond.Hypomethylating agent therapy can delay the disease,but can't prevent progression.

关 键 词：慢性粒单核细胞白血病 去甲基化药物 完全缓解 总生存期 安全性 

分 类 号：R733.72[医药卫生—肿瘤]