地西他滨联合改良CAG及单倍体相合外周血淋巴细胞回输治疗老年高危恶性血液病

Clinical Efficacy of Decitabine plus Improved CAG Chemotherapy and Haplo-identical Donor Peripheral Lymphocyte Infusion Regimen on Elderly Patients with High Risk Myelodysplastic Syndrome and Acute Myeloid Leukemia

本研究旨在观察地西他滨联合改良CAG及单倍体相合外周血淋巴细胞回输免疫治疗新方案,作为初治老年高危骨髓增生异常综合征(MDS)和急性髓系白血病(AML)的诱导缓解方案的初步疗效及其不良反应。对2012年4月至2012年7月在本院血液科应用地西他滨联合改良CAG及HLA半相合外周血淋巴细胞回输免疫治疗新方案治疗的5例老年高危MDS和AML患者进行前瞻性研究,观察完全缓解率及副反应。结果表明:5例初治老年患者治疗总有效率100%,4例达到完全缓解,1例患者达到部分缓解。既往无MDS病史患者,中性粒细胞数恢复至0.5×109/L的中位时间为15 d,血小板数恢复至20×109/L的中位时间为16 d。主要副作用为IV度骨髓抑制,全部患者治疗中无新发肺部感染等严重并发症。结论:地西他滨联合改良CAG及外周血淋巴细胞回输免疫治疗新方案,治疗老年MDS和AML患者安全有效,值得进一步研究。

This study was aimed to observe the clinical efficacy and adverse effects of decitabine plus improved CAG chemotherapy and haploid identical donor peripheral lymphocyte infusion regimen on elderly patients with myelodysplas tic syndrome （MDS） and acute myeloid leukemia （AML）. Five elderly patients with MDS and AML were treated with decitabine plus improved CAG chemotherapy and donor peripheral lymphocyte infusion regimen. Examinations on liver and renal function, electrocardiogram and bone marrow analysis were performed before and after treatment, and adverse effects were observed. The results indicated that after a course of treatment by decitabine plus improved CAG chemother apy and haploidentical donor peripheral lymphocyte infusion regimen, the total effective rate was 100%, and 4 patients （80%） achived complete remission, 1 patient achived partial remission. The dominant clinical adverse effect was bone marrow depression, the median time of neutrophil 〉 0.5 x 109/L and platelet 〉 20 x 109/L was 15 d and 16 d respective ly for patients without previous MDS. It is concluded that decitabine plus improved CAG chemotherapy and haploidi dentical donor peripheral lymphocyte infusion regimen may be effective with less adverse effects for elderly primary AML and high risk MDS patients, it is a promising therapeutic methods and worthy to deeply study.