地西他滨治疗中、高危骨髓增生异常综合征的临床观察

Clinical Observation of Decitabine in the Treatment of Median and High Risk Myelodysplastic Syndrome

目的:观察地西他滨治疗中、高危骨髓增生异常综合征(MDS)的临床疗效及安全性。方法:选择MDS患者8例,所有患者初次使用地西他滨前均给予异丙嗪25 mg肌肉注射,地塞米松5 mg静脉注射,之后均给予低剂量地西他滨15 mg/m2静脉滴注,q8h,连用3 d,休息25 d,28 d为1个疗程。视患者情况给予不同疗程治疗。监测所有患者治疗前后血常规、肝肾功能、骨髓细胞学、肺部感染等情况,观察所有患者临床疗效及不良反应发生情况,并随访所有患者12个月的疗效。结果:治疗1个疗程后血液学改善的患者有8例;治疗2个疗程以上完全缓解的患者有2例,部分缓解的患者有3例,血液学改善的患者有1例。7例患者出现Ⅲ～Ⅳ度血液学不良反应,发生率为87.5%,同时均存在不同程度的肺部感染;所有患者均未出现Ⅲ～Ⅳ度出血、恶心呕吐和肝功能损害。随访12个月,3例仍存活,1例失访,4例死亡。结论:地西他滨可有效治疗中、高危MDS,提高患者的生存质量,但血液学不良反应较严重,临床使用时需要给予积极的支持治疗;地西他滨治疗过程中原发性耐药或者疾病进展的患者预后极差。

OBJECTIVE： To observe the clinical efficacy and safety of decitabine in the treatment of median and high risk my- elodysplastic syndrome （MDS）. METHODS： 8 MDS patients were collected from a hospital. All patients were given intramuscular injection of phenergan 25 mg and intravenous injection of dexamethasone 5 mg, and then given low dose of decitabine 15 mg/m~, qSh lbr consecutive 3 days and drug withdrawal lbr 25 days. A treatment course lasted for 28 days. The treatment plan was adjusted according to disease condition. Blood routine, liver and kidney function, marrow cells cytology, pulmonary infection and other changes of all patients were monitored before and after treatment. Therapeutic efficacy and adverse drug reactions were evaluated. Those patients were tbllowed up for 12 months. RESULTS： After a treatment course, the hematology improvement was found in 8 cases： 2 cases achieved complete remission（CR）, 3 cases achieved partial remission（PR）and a case achieved hematological im- provement（HI ）. 7 patients suffered from Ill-IV grade hematological toxicity with incidence of 87.5%, and different degrees of pul- monary infection. No Ill-IV grade bleeding, nausea, vomiting and liver injury was observed. Atter 12 months follew-up, 3 patients survived, a patient thiled to be followed up and 4 patients were dead. CONCLUSIONS： Decitabine can effectively treat median and high-risk MDS and improve quality of life. Active supportive treatment is required due to severe hematologic adverse reactions. MDS patients who lose response or progress have extremely poor prognosis.