小剂量高三尖杉酯碱、阿糖胞苷联合G-CSF治疗急性髓细胞白血病28例临床分析

Low dose of homoharringtonine and cytarabine combined with G-CSF for treatment of acute myelocytic leukemia:report of 28 cases

目的：探讨小剂量高三尖杉酯碱（HHT）、阿糖胞苷（Ara-c）联合粒细胞集落刺激因子（G-CSF）即HAG方案治疗急性髓细胞白血病（acute myelocytic leukemia,AML）的疗效。方法：28例AML中M1 3例,M2a 10例,M2b 1例,M4 2例,M5 8例,骨髓增生异常综合征（MDS）4例,均行HAG方案治疗。HHT1 mg/d及Ara-c 25-50 mg/d静脉滴注第1-14天,G-CSF 150-300μg/d皮下注射,如WBC〉20×109/L,则暂停用G-CSF,待WBC回落后继续使用。结果：AML达完全缓解15例,其中4例采用米妥蒽醌＋阿糖胞苷、吡柔比星＋阿糖胞苷化疗1-2疗程未缓解者,有效率（部分缓解＋完全缓解）为78%（22/28）。28例中有10例≥60岁,完全缓解7例,化疗不良反应轻。结论：HAG方案对AML的疗效明显,且对老年性、继发性或耐药性白血病效果肯定。

Objective ：To explore the clinical effect of low dose of homoharringtonine （HHT）and cytarabine （Ara-c） combined with granulocyte colony-stimulating factor（ G-CSF ） （ HAG regimen ） in treating acute myelocytic leukemia （ AML ）. Methods ： Twenty-eight patients with AML including 3 cases of M1,10 cases of M2a, 1 case of M2b,2 cases of M4,8 cases of M5 and 4 cases of myelodysplas-ticsyndrome（MDS） were treated with HAG regimen. HHT 1 mg/d intravenous infusion and Ara-c 25 -50 mg/d intravenous infusion were administered from 1 st to 14th day;G-CSF 150 -300 μg/d was injected subcutaneously. If the white blood cell count rose to 20×10^9/L,G-CSF was suspended until the WBC dropped to normal. Results：Complete remission （CR）and partial remission （PR）were observed in 22 of the total 28 cases （78%）. Among the 15 CR cases,4 bad received mitoxantrone and cytarabine, pirarubicin and cytarabine regimen for two cycles before but had achieved no remission. Ten of the 28 cases were elderly AML （ ≥60 years） , and CR was noted in 7 of them. Conclusions：The regimen of low dose of homoharringtonine and cytarabine in combination with G-CSF is effective for patients with relapsed and/or secondary acute myeloid leukaemia, especially the elderly.