不同剂量地西他滨联合减剂量HAG治疗中高危MDS及老年AML患者的有效性和安全性回顾分析

Retrospective analysis of the efficacy and safety of different doses of decitabine combined with reduced-dose HAG in the treatment of intermediate or high-risk MDS and old patients with AML

目的探究不同剂量地西他滨(decitabine,DAC)联合减剂量HAG治疗中高危骨髓增生异常综合征(myelodysplastic syndrome,MDS)及老年急性髓系白血病(acute myeloid leukemia,AML)的有效性和安全性。方法收集徐州医科大学附属宿迁医院(南京鼓楼医院集团宿迁医院)2015年1月~2021年1月收治的89例中高危MDS、老年AML患者的临床资料,进行回顾性分析。根据DAC剂量的不同分为A组(51例)、B组(38例)。A、B组分别给予DAC 20 mg/(m^(2)·d)、10 mg/(m^(2)·d),同时联合减剂量HAG方案治疗,28 d为一个疗程。2个疗程后评估患者疗效,比较治疗前后MDS/AML患者的血常规指标及两组患者治疗期间的不良反应率及随访1年的生存情况。结果A组总有效率为86.27%,高于B组的68.42%(P<0.05);治疗后,两组患者红细胞、血红蛋白及血小板水平升高,白细胞水平降低,A组血常规指标水平均优于B组(P<0.05);A、B组患者不良反应发生率、平均及中位生存时间均无明显差异(P>0.05);A组存活率74.51%(38/51),B组1例患者于随访过程中失访,B组存活率67.67%(25/37),A、B组平均生存时间分别为(11.81±0.57)个月、(9.98±0.49)个月,2组1年生存曲线经Log-Rank检验,差异无显著性(Log-Rankχ^(2)=0.907,P=0.341)。结论20 mg/(m^(2)·d)的DAC联合减剂量HAG能够有效提高中高危MDS及老年AML患者的临床疗效,改善血常规指标,安全有效。

Objective To explore the efficacy and safety of different doses of decitabine(DAC)combined with reduced-dose HAG in the treatment of intermediate or high-risk myelodysplastic syndromes(MDS)and old patients with acute myeloid leukemia(AML).Methods The clinical data of 89 patients with intermediate or high-risk MDS and old patients with AML admitted to Suqian Hospital Affiliated to Xuzhou Medical University(Nanjing Gulou Hospital Group Suqian Hospital)from January 2015 to January 2021 were collected and analyzed retrospectively.According to the different doses of DAC,they were divided into group A(51 cases)and group B(38 cases).Groups A and B were given DAC 20 mg/(m^(2)·d)and 10 mg/(m^(2)·d),respectively,combined with a reduced-dose HAG regimen,28 days as a course of treatment.The curative effect of the patients was evaluated after 2 courses of treatment,and the blood routine indexes of patients before and after treatment,the adverse reaction rate during treatment and the 1-year follow-up survival of the two groups of patients were compared.Results The total effective rate of group A was 86.27%,which was higher than 68.42%of group B(P<0.05).The levels of red blood cells,hemoglobin and platelets in the two groups were increased after treatment,and the white blood cells were decreased,and the blood routine index levels in the group A were better than those in the group B(P<0.05).There was no significant difference in adverse reaction rate,mean and median survival time between group A and B(P>0.05).The survival rate of group A was 74.51%(38/51),1 patient in group B was released during the follow-up,and the survival rate of group B was 67.67%(25/37).The average survival time of group A and B were(11.81±0.57)months and(9.98±0.49)months,respectively.The 1-year survival curves of the two groups were tested by Log-Rank,and there was no significant difference(Log-Rankχ^(2)=0.907,P=0.341).Conclusion 20 mg/(m^(2)·d)DAC combined with reduced-dose HAG can effectively improve the clinical efficacy of patients with intermediate or high-risk MDS and old patients with AML,and improve blood routine indexes,which is safe and effective.