去铁胺治疗骨髓增生异常综合征铁过载的临床疗效及其对预后的影响

Clinical efficacy and prognostic analysis on the use of defetoxamine for transfusion-dependent iron overload in patients with myelodysplastic syndromes

目的探讨去铁胺治疗骨髓增生异常综合征铁过载的临床疗效及其对预后的影响。方法选取我院2004年6月至2011年6月收治的79例骨髓增生异常综合征铁过载患者,按照血清铁蛋白(SF)水平将患者分为3组,所有患者均给予静脉滴注甲磺酸去铁胺治疗,2周为1个疗程,间隔2周,共治疗4个疗程。分别对每组患者的治疗效果、生存时间和不良反应进行分析。结果血清铁蛋白Ⅰ、Ⅱ和Ⅲ期患者对去铁胺的反应率分别为86.04%、58.33%和16.67%,各期的反应率比较,差异有统计学意义(P<0.05)。3组患者的中位生存时间分别为>36、33、19个月,各组患者的中位生存时间比较,差异有统计学意义(P<0.05)。3组患者的不良反应发生率比较差异无统计学意义(P>0.05)。结论去铁胺治疗骨髓增生异常综合征铁过载的疗效与患者基础SF水平存在一定的关系,其不良反应轻微,SFⅠ期的骨髓增生异常综合征患者的生存获益最大。

AIM To explore clinical effect and prognosis of defetoxamine for transfusion-dependent iron overload in patients with myelodysplastic syndromes （MDS）. METHODS A total of 79 MDS patients with transfusion-dependent iron overload from June 2004 to June 2011 were divided into 3 groups according to serum ferritin level. All the patients were administered with defetoxamine by intravenous injection. A course of treatment was 2 weeks, with the interval of 2 weeks, totally 4 courses. The response rate, median survival time and adverse drug reaction （ADR） were evaluated. RESULTS The response rate was 86.04% ,58.33% and 16.67% in stages I , 1] and m respectively （P 〈 0.05）. The median survival time was 〉 36,33 and 19 months in stages I , II and m respectively （P 〈 0.05）. There was no significant difference in ADR among 3 groups （ P 〉 0.05）. CONCLUSION There is a possible correlation between cu- rative effects of defetoxamine and the level of the basal serum ferritin in MDS patients, while the ADR was mild. The stage I patients with the treatment of defetoxamine show better result in survival time than that of stage U or m patients.