依硫磷酸治疗骨髓增生异常综合征疗效的Meta分析

Efficacy of amifostine in the treatment of myelodysplastic syndrome: a metaanalysis of 220 patients from 18 studies

目的:分析依硫磷酸治疗骨髓增生异常综合征(MDS)的临床疗效和不良反应,以指导MDS的治疗。方法:以amifostine、myelodysplasticsyndrome和therapuetics以及依硫磷酸和MDS为主题词在中英文数据库中检索所有依硫磷酸治疗MDS的临床研究。结果:共检索到24篇依硫磷酸治疗MDS的论文,一共有220例患者纳入研究,其中符合总疗效分析条件的患者一共有195例。在60例输血依赖患者当中,24例(14.7%)治疗后脱离输血,36例(60.0%)输血间隔延长一倍以上;140例粒细胞缺乏患者治疗后69例(49.3%)粒细胞上升超过一倍以上;在57例RAEB和RAEB-t患者当中,无一例幼稚细胞减少。不良反应主要有食欲下降61例(41.2%),恶心53例(35.8%),皮疹13例(8.8%),呕吐12例(8.1%),低血压11例(7.4%),疲劳感9例(6.1%),打喷嚏3例(2.0%),无症状低钙血症2例(1.3%),深静脉血栓2例(占1.3%)。结论:依硫磷酸可用于治疗细胞减少的难治性/复发性MDS。但对于血栓性疾病患者慎用。

Objective：To analyze the efficacy and side effects of amifostine in the treatment of myelodysplastic syndrome （MDS） in order to providing a basis for a decision model for the use of amifostine in MDS. Method： Amifostine, myelodysplastic syndrome and therapuetics were used as subjects to search all clinical papers related with amifostine in the treatment of MDS. Result：This Meta-analysis included 18 original articles with a total of 220 patients with MDS and there were 195 patients were suitable for the efficacy analysis. The average response rate for improving anemia was 36.8% （60） in 163 anemia patients treated with amifostine and 14.7%（24） patients were independent of transfusion among 60 transfusion dependent patients after treated with amifostine. Transfusion interval of another 36 patients （60%） doubled or more. The neutrophil number of 69（49.3%） patients increased significantly among 140 neutropenic patients. There was no blast decrease among all 57 RAEB and RAEB-t patients. Main side effects during and after amifostine treatment included decreased appetite （61, 41.2%）, nausea （53, 35. 8%）, pruritis （13, 8.8%）, vomiting （12, 8. 1%）, transient hypotension （11, 7. 4%）, fatigue （9, 6. 1%）, sneezing （3, 2.0%）, asymptom hypocalcemia （2, 1.3%）, deep venous thrombosis （2, 1.3%）. Conclusion：Amifostine could be safely used in the treatment of relapse and/or refratory MDS. Amifostine may be not suitable for the patients with thrombosis.