循环应用CAG，IA方案治疗高危骨髓增生异常综合征临床疗效观察

Cyclic Application of CAG and IA Regimens in the Treatment of Advanced Myelodysplastic Syndrome

目的观察循环应用CAG，IA方案治疗高危骨髓增生异常综合征（MDS）的临床疗效。方法12例高危MDS患者首先接受由Acla，Ara—C及G-CSF组成的-CAG方案诱导缓解治疗，达完全缓解（CR）或部分缓解（PR）后应用IDA联合Ara-C的IA方案化疗1疗程；NR患者再次应用同剂量的CAG方案，获得缓解的加用IA方案，仍未缓解的视为无效，退出观察组。后循环应用CAG，IA方案进行化疗，每年3—5次，具体用药剂量及周期视患者个体情况判断。结果两个疗程后12例患者中，CR2例，PR7例，NR3例，CR率为16．7％，总有效率为75％．中位生存时间18个月（6～40个月），1年总生存率83．3％，2年总生存率58．3％，3年总生存率16．7％．无严重化疗相关毒副反应，化疗相关死亡率为9．3％．结论CAG方案诱导缓解治疗高危MDS有效率高，毒副反应轻，循环应用CAG—IA方案安全有效。

Objective To observe the clinical efficacy of cyclic application of CAG and IA regimens in the treatment of high-risk myelodysplastic syndrome （ MDS）. Methods Twelve patients with high-risk MDS were enrolled in this trial to accept the induction remission therapy of CAG regimen which includes aclarubicin, arabinosylcytosine and granulocyte colony-stimulating factor at first. If CR or PR reached then Ara-C regimen was applied, otherwise, IA regimen was applied after the same CAG regimen again （ invalid ones were out of the trial ）. Then after 3 - 4 weeks, CAG and IA regimens were applied in circles （ 3 - 5 circles one year） , the specific dose and cycle of which was depending on individual. Results Two patients achieved CR （ 16.7 % ） and 7 patients achieved PR, other 3 had no response, the total effective rate reached to 75%. The median survival time was 18 months（6 -40months） , 1-year overall survival rate was 83. 3% ,2-year overall survival rate was 58.3% and 3-year overall survival rate was 16.7%. Toxic side effect was less seri- ous,the death rate of chemotherapy was 9.3%. Conclusion The clinical efficacy of cyclic application of CAG and IA regimens in the treatment of high-risk MDS is safe and effective. CHG regimen has high response rate and mild toxic side effect.