环孢素A联合CAG方案治疗MDS转化的急性白血病疗效观察

Clinical Effect of Cyclosporin A Combined with CAG Regimen on Acute Myelocytic Leukemia Transformed from Myelodysplastic Syndrome

目的探讨环孢素A(CsA)联合CAG方案治疗骨髓增生异常综合征(MDS)转化的急性白血病的疗效和不良反应。方法对16例MDS/AML患者实施CsA联合CAG方案诱导治疗,1个疗程后评估疗效,无效者退出,有效者继续接受下个疗程治疗。随访分析14例患者生存期,评判CsA联合CAG方案的长期疗效。结果 16例MDS/AML患者,1疗程后4例达CR(25.0%),6例达PR(37.5%),4例NR(25.0%);2疗程CR 43.8%,总有效率62.5%。7例大于≥60岁的老年患者中,2疗程1例达CR(14.3%),2例达PR(28.6%),2例NR(28.6%),2例早期死亡,有效率42.9%。随访14例患者中位生存时间11月,1年、2年的生存率分别为50.0%,21.4%。临床不良反应主要为骨髓抑制,其中中性粒细胞<0.5×109/L发生率87.5%,PLT<20×109/L发生率81.3%。结论 CsA联合CAG方案治疗MDS/AML安全有效,疗效较为满意。

Objective To explorethe clinical efficacy and toxicity of cyclosporin A（CsA） and CAG regimen on acute myelocytic leukemia（AML） transformed from myelodysplastic syndrome（MDS）.Methods Sixteen patients with MDS/AML were treated with CsA and CAG regimen.The initial outcome was evaluated after the first course of treatment.The responders received the second course.Fourteen patients were followed up,life span was analysed,and long-term efficacy of CsA and CAG regimen was evaluated.Results After a course of treatment by CsA and CAG regimen,four patients（25.0%） experienced complete remission,six patients（37.5%） experienced partial remission,and four patients（25.0%） cured failure.The total effective rate was 62.5% and complete remission percentage was 43.8% after the second course of treatment.One patient achieved complete remission, two achieved partial remission,and two had no effect among seven patients whose ages exceeded sixty.One patient died of lung infection and one died of brain hemorrhage.The median time of follow up was 11 months and the survival rates were 50.0% and 21.4% at one year and two years after chemotherapy.The dominant clinical adverse effects were bone marrow depression,with 87.5% of agranulocytosis（neutrophil0.5 × 109 / L） and 81.3% of thrombocytopenia（platelet0.5 × 109 / L）.Conclusion The combined CsA and CAG regimen treatment was safe and offered one plan which one was practically.