地西他滨联合改良CAG方案治疗AML1-ETO阳性复发、难治急性髓系白血病的临床研究

Clinical Efficacy of Decitabine Combined with Modified CAG Regimen for Relapsed-Refractory Acute Myeloid Leukemia with AML1-ETO^+

本研究旨在分析AML1-ETO阳性复发、难治急性髓系白血病的临床特点及地西他滨联合改良CAG方案对该类白血病患者的治疗效果及副作用。回顾性分析2013年1月至8月5例AML1-ETO阳性复发、难治急性髓系白血病,并分析临床特点,包括年龄、性别、初诊时伴随症状、外周血和骨髓特点等;同时分析地西他滨联合改良的CAG方案对该类患者的治疗效果和副作用。5例患者中复发2例,难治合并复发3例,初治时白细胞中位数12.55(7.8-66.55)×109/L、血小板中位数44(20-72)×109/L,血红蛋白中位数110(77-128)g/L、乳酸脱氢酶中位数312.9(123.6-877.8)μ/L。治疗结果表明:经过1个疗程地西他滨联合改良的CAG方案治疗后4例完全缓解,1例未缓解,总缓解率为80%;治疗的副作用主要为骨髓抑制,1例未缓解经FLAG方案治疗后在移植动员过程中突发心衰死亡。结论:初步结果表明AML1-ETO阳性复发、难治急性髓系白血病经本方案治疗后,其缓解率比较高、并发症较少,值得进一步研究和在临床推广应用。

This study was aimed to investigate the clinical characteristics of relapsed-refractory acute myeloid leukemia （AML） with AML1-ETO ＋,and its therapeutic efficacy and side effects when decitabine combined with modified CAG regimen was used.Clinical data of 5 cases of AML with AML1-ETO ＋ from January 2013 to Agust 2013 were analyzed retrospectively.The analyzed data included age,sex,initial symptoms,peripheral blood and bone marrow characteristics.Meanwhile,the therapeutic effecacy and side effects of decitabine combined with modified CAG regimen were evaluated.The 5 patients were with median age of 35 （17-43） years.Among these 5 patients,2 patients were relapsed and other 3 patients were relapsed-refractory patients,their median white blood cell count was 12.55 （7.8 -66.55） × 109/L,median platelets count was 44（20-72） × 109/L,median hemoglobin level was 110 （77-128） g/ L,median lactate dehydrogenase level was 312.9 U/L （123.6-877.8） at the initial diagnosis.The results showed that after decitabine combined with modified CAG regimen was administered,4 patients achieved complete remission,1 patient did not achieve remission,the overall remission rate-was 80% （4/5）.The main side effects of this regimen was myelosupp-ression,these were no new lung infection and other serious complications,one case without complete remission treated with FLAG once again died of heart failure when being mobilized for transplantation.It is concluded that according to preliminary results of decitabine combined with modified CAG regimen for relapsed and refractory AML patients with AML1-ETO ＋ displays higher remission rate and lower side effects,which worthy to further explore for clinal application.