地西他滨治疗移植后复发MDS/AML及高危AML患者的临床疗效分析

Analysis of Decitabine Therapeutic Effeicacy for Patients with Relapsed MDS/AML and High-Risk AML Patients after HSCT

目的:探讨异基因造血干细胞移植(allo-HSCT)后复发的骨髓增生异常综合征/急性髓系白血病(MDS/AML)患者应用含地西他滨的化疗方案缓解后继续维持治疗的效果及高危AML在allo-HSCT后进行预防性输注地西他滨的疗效。方法:对2016年11月至2018年5月于本院行allo-HSCT术后的10例MDS/AML患者进行回顾性分析,包括AML 4例,MDS 2例,MDS转化的AML(t-AML)4例。10例患者中移植后复发8例,高危AML移植后应用地西他滨预防2例。复发组患者应用地西他滨+化疗达完全缓解(CR)后,继续应用地西他滨维持治疗;预防组患者在移植后30至45 d、无移植物抗宿主病(GVHD)前提下,给予预防性地西他滨输注。8例患者辅以G-CSF动员的供者淋巴细胞输注(DLI)。地西他滨维持治疗及预防性输注的剂量为5 mg/m2×(7-10)d,每4-6周为1个疗程,共3-7个疗程。结果:随访至2018年11月30日,10例患者中7例无病存活,平均生存期为15.5±1.9个月,1年总生存(OS)率为64.0%。10例患者中发生急性GVHD及慢性GVHD者分别为6例和4例。结论:应用地西他滨+DLI治疗allo-HSCT后复发MDS/AML及高危AML患者在allo-HSCT后预防应用地西他滨,可延长无病生存期,降低复发率,为患者获得长期生存提供可能。

Objective:To investigate the therapeutic efficacy of using decitabine as maintenance therapy for patients with relapsed MDS/AML and as prophylactic therapy for patients with high-risk AML after allogeneic hematopoietic stem cell transplantation(allo-HSCT).Methods:Clinical data of 10 patients with MDS/AML from November 2016 to May 2018 were analyzed retrospectively.Among 10 patients there were 4 cases of AML,2 cases of MDS,and 4 cases of AML transformed from MDS(t-AML).The 10 patients were devided into 2 groups:the relapsed group(n=8)and the prophylactic group(n=2).In relapsed group the decitabine was used as maintenance therapy after achieved complete remission(CR)with decitabine chemotherapy.In prophylactic group the decitabine was used as prophylactic therapy if the patients didn′t appear the symptom of graft-versus-host-disease(GVHD)during 30 to 45 d after allo-HSCT.Eight patients received G-CSF-mobilized donor lymphocyte infusion(DLI).The dosage of decitabine for maintenance therapy and prophylactic therapy was 5 mg/m^2 for 7 to 10 days every 4 to 6 weeks,as 1 cycle,amount to 3 to 7 cycles.The dosage was adjusted by the endurance of patients.Results:Until Nov 30,2018,7 out of 10 patients survived.The average survival time was 15.5±1.9 months.1-year OS rate was 64.0%.Six patients appeared aGVHD,and four patients appeared cGVHD.Conclusion:The usage of decitabine combined with DLI in patients with relapsed MDS/AML and high-risk AML after allo-HSCT can prolong lives of patients,reduce relapsed rate,and provide the probability for long time survival.