增加地西他滨剂量治疗高危组骨髓增生异常综合征及急性髓系白血病20例分析

Effect of increased-dose decitabine in patients with high-risk myelodysplastic syndrome and acute myeloid leukemia:an analysis of 20 cases

目的探讨增加地西他滨剂量治疗高危组骨髓增生异常综合征(MDS)及急性髓系白血病(AML)的疗效。方法收集2009年9月至2012年1月在苏州大学附属第一医院高危组MDS及AML患者20例,静脉滴注地西他滨20 mg/m2,每日1次,连用5 d治疗,然后行骨髓检查,根据患者骨髓增生程度、原始细胞数、骨髓小粒饱满情况,结合患者的一般情况、不良反应,酌情增加使用地西他滨,分析治疗1个疗程后缓解率和总反应率。结果 MDS患者1个疗程完全缓解(CR)+骨髓CR为3例(75%),总反应3例(75%);AML患者1个疗程CR+骨髓CR 3例(18.8%),总反应8例(50.0%),其中初治患者1个疗程CR+骨髓CR 1例(25.0%),总反应3例(75.0%),复发及难治患者1个疗程CR+骨髓CR 2例(16.7%),总反应5例(41.7%)。累积2年生存率为42%。结论剂量增加的地西他滨可被安全应用于高危组MDS及AML,1个疗程缓解率较高,值得进一步探索。

Objective To assess the efficacy of increased-dose decitabine for the treatment of patients with high-risk myelo- dysplastic syndrome and acute myeloid leukemia （MDS/AML）. Methods Twenty consecutive patients with high-risk MDS/AML were enrolled from First Affiliated Hospital of Suzhou Medical University between September 2009 and January 2012 and were treated with a 5-day decitabine intravenous injection （20 mg/m2, once daily）. Additional dose of decitabine was determined based on the proliferation of marrow, progenitor cell counts and proportion of marrow granulose via bone marrow aspiration in combination with general conditions and adverse reactions. The relapse and response rates were ana- lyzed after a treatment course. Results Both complete remission （CR） ＋ marrow CR rate and overall response rate were 75% （n =4） in patients with high-risk MDS after the initial treatment course. Patients with AML yielded CR ＋ marrow CR rate and overall response rate of 18.8% （n =3） and 50% （n =8） ,respectively. And these figures were 25% （n --4） and 75% （n =3） in those who received initial chemotherapy, 16. 7% （n =2） and 41.7% （n = 12） in relapsed/refractory pa- tients. A 2-year cumulative survival rate of 42% was reported. Conclusion Increased-dose decitabine may be administered in patients with high-risk MDS/AML in a safe fashion. The fact that single treatment course results in high remission rate re- mains to be explored.