预激方案治疗中高危骨髓增生异常综合征疗效观察

Curative effect of low dose cytarabine and aclarubin in combination with granulocyte colony-stimulating factor priming (CAG regimen) on patients with the intermediate and high-risk myelodysplastic syndrome

目的:观察预激方案治疗中高危骨髓增生异常综合征(myelodysplastic syndrome,MDS)的疗效和不良反应。方法:回顾分析46例初治MDS患者,18例采用标准化疗,28例采用预激方案。采用预激方案者第1～8天静脉滴注阿柔比星10mg/(m2·d),第1～14天皮下注射阿糖胞苷10mg/m2,每12小时1次,皮下注射粒细胞集落刺激因子200μg/(m2·d),在第1次注射阿糖胞苷之前开始,至最后1次注射阿糖胞苷之前12h停用。1个疗程后初步评价疗效,有治疗反应者继续第2个疗程治疗,2个疗程结束后评价最终疗效。结果:预激组完全缓解13例(46.4%),部分缓解5例(17.9%),血液学改善4例(14.3%),总有效率为78.6%(22/28)。标准化疗组完全缓解6例(33.3%),部分缓解2例(11.1%),血液学改善1例(5.6%),总有效率为50%(9/18)。预激组总有效率高于标准化疗组(P<0.05),两组之间完全缓解率比较差异无统计学意义(P>0.05)。预激组不良反应较轻。结论:预激方案治疗中高危MDS安全有效,长期疗效仍需进一步观察。

Objective To evaluate the curative effect and adverse effect of low dose cytarabine and aclarubin in combination with granulocyte colony-stimulating factor priming （CAG regimen） on patients with the intermediate and high-risk myelodysplastic syndrome.Methods A total of 46 patients with intermediate and high-risk myelodysplastic syndrome was retrospectively analyzed.Twenty-eight patients received CAG regimen and 18 received conventional chemotherapy.CAG regimen：aclarubicin 10 mg/（m^2·d）intravenously daily,Day 1～8;cytarabine 10 mg/m^2 subcutaneously once every 12 hours,Day 1～14;and subcutaneously use of granulocyte colony-stimulating factor 200 μg/（m^2·d） until 12 hours before the last use of cytarabine.The initial outcome was evaluated after the first course of treatment.The responders received the second course.The ultimate therapeutic effect was evaluated after the 2 courses.Results The overall response rate in the CAG regimen group was 78.6% （22/28）.Thirteen patients （46.4%） responded,5 （17.9%） showed partial response,and 4 （14.3%） hematologic improvement.The overall response rate in the conventional chemotherapy group was 50%（9/18）.Six patients （33.3%） achieved complete response,2 （11.1%） partial response,and 1（5.6%） hematologic improvement.The overall response rate of the CAG group was significantly higher than that in the control group （P〈0.05）.The adverse effects of CAG regimen were bearable.Conclusion With acceptable adverse effect,CAG regimen is effective for the intermediate and high-risk myelodysplastic syndrome.Long-time outcome needs further observation.