FLAG方案治疗难治复发急性髓系白血病13例

Effects of FLAG regimen in treatment refractory and relapsed acute myeioid leukemia

目的观察FLAG方案治疗难治复发急性髓系白血病（AML）的疗效、骨髓抑制时间以及患者不良反应。方法氟达拉滨30mg·m^-2·d^-1，第1天至第5天；阿糖胞苷2g·m^-2·d^-1，第1天至第5天；粒细胞集落刺激因子300μg／d，第0天至第5天或视具体晴况用至中性粒细胞计数（ANC）≥1×10^9／L。治疗13例（17例次）难治复发AML。其中难治性AML5例、复发性AML8例。男9例，女4例。中位年龄41．8（28～67）岁。结果17例次中11例次有效，6例次完全缓解（CR率35．3％），5例次部分缓解（PR率29．4％），总有效率64．7％。CR的患者中有I例已行异基因造血干细胞移植，目前一直处于无病生存状态达8个月。毒副作用主要为骨髓抑制、消化道症状、轻度肝功能异常。中性粒细胞最低时间在开始用药后5～12d，持续时间7～34d，血小板最低时间在开始用药后5—13d，持续时间8～30d。结论FLAG方案对难治复发AML有较好疗效，血液学和非血液学毒副作用可以耐受，为患者行造血干细胞移植创造了机会。

Objective To investigate the therapeutic effects, duration of hematopoietic depression and side effects of FLAG regimen for refractory and relapsed acute myeloid leukemia（AML）. Methods 13 cases （17 times） with refractory and relapsed AML were treated with fludarabine 30 mg·m-2·d-1 and Ara-C 2 g·m-2·d-1 for 5 days, and granulocyte colony stimulating factor G-CSF 300μ g/d from day 0 till neutrophil recovery （ANC≥1×10^9/L）. 13 patients were 8 males and 5 females. The median age was 41.8 years（range 28-67）. It includes 5 relapsed AML patients and 8 refractory AML patients. Results Of the 17 times, 11 showed response to therapy; the rate of complete remission was 35.3 %（6/17）; the rate of partial remission was 29.4 % （5/17） and the overall response rate was 64.7 %. Main toxicities were gastrointestinal side effects, myelosupression and the function of liver was lightly damaged. Neutropenia at lowest number began at the time of 5-12 days after regimen initiating and last 7-34 days, thrombocytopenia began at the time of 5-13 days and last 8-30 days. Conclusion FLAG regimen showed obvious effects for refractory and relapsed AML. Most patients gained chance for hematopoietic stem cell transplantation. Hemotological and nonhemotological toxicities are acceptable.