小剂量CHG预激方案治疗老年人急性髓系白血病的临床研究

Inductive chemotherapy with low-dose CHG stimulating regimen in elderly acute myeloid leukemia

目的 探讨小剂量CHG预激方案[小剂量阿糖胞苷（Ara-C）、高三尖杉酯碱（HHT）联合粒细胞集落刺激因子（G-CSF）]对老年急性髓系白血病（AML）的治疗疗效和毒副作用.方法 选择年龄＞60岁的AML初治患者共35例,采用CHG方案治疗：在化疗前12 h皮下注射粒细胞集落刺激因子（G-CSF）200μg/m^2后,应用14d,HHT1 mg/m^2,第1天至第14天,1次/d;Ara-C 10mg/m^2,第1天至第14天,皮下注射,每12h 1次.治疗过程中,WBC＞20×10^9/L时暂停使用G-CSF,但不停化疗,待WBC回落后再继续使用.对完全缓解（CR）者后期可选择不同方案交替巩固化疗.结果 第1个疗程后12例患者获得CR,15例获得部分缓解（PR）,8例未缓解（NR）.第2个疗程后,15例PR患者5例取得CR,8例NR患者有2例获得PR,总有效率83%（29/35）.17例获得CR的患者中11例按计划巩固强化治疗未复发,生存期为12～34个月,中位生存18个月;6例复发,经过原方案诱导后1例CR、4例PR、1例NR.CHG方案血液学毒性低,非血液学毒性不明显.结论 初治的老年AML患者采用小剂量CHG预激方案诱导缓解的疗效较好、不良反应可耐受.

Objective To explore the efficacy and side effect of inductive chemotherapy with lowdose,cytarabine,homoharringtonine and granulocyte colony-stimulating factor（CHG） in elderly acute myeloid leukemia（AML）. Methods Thirty-five elderly patients （age〉60 years） with AML were enrolled for the initial treatment with CHG regimen,The CHG regimen consisted of cytarabine 10 mg/m2 per 12 h by subcutaneous injection,days 1-14,homoharringtonine 1 mg/m2 per day by intravenous continuous infusion,days 1-14,and G-CSF 200 μg/m2 per day by subcutaneous injection 12 h before chemotherapy,days 0-14. G-CSF only was used when white blood cell count（WBC） was less than 20×109/L during the whole course. Results After the first course,12 patients achieved complete response （CR）,15 patients achieved partial response（PR）,and 8 patients had no response（NR）. After the second course,5 of 15 PR patients achieved CR,2 of 8 NR patients achieved PR. The total effective rate was 82 % （29/35）. Of those 17 CR patients,eleven patients continued maintenance therapy and remained in remission for 12-34 months with a median CR duration of 18 months,the other 6 patients relapsed and were treated with original regimen,including one achieved CR again,4 achieved PR,and 1 achieved NR. The CHG regimen had mild hematologic toxicities and no severe nonhematologic toxicities. Conclusion CHG regimen is effective and well tolerated in remission for elderly AML.