CLAG方案治疗复发/难治性急性髓细胞白血病疗效观察

Combination of cladribine and middle doses of arabinoside cytosine and G-CSF(CLAG regimen)in treatment of refractory/relapsed acute myeloid leukemia

目的：观察克拉屈滨联合中剂量阿糖胞苷（Ara-C）及粒细胞集落刺激因子（G-CSG）（CLAG方案）治疗复发/难治性急性髓细胞白血病（AML）的疗效及毒副作用。方法：观察组为2012-03-2014-02治疗的18例复发/难治性AML,治疗方案：克拉屈滨5mg/m2,静脉滴注,第1～5天;Ara-C 2g/m2,静脉滴注,q12h,第1～5天;G-CSF 300μg,皮下注射,第0～5天。对照组为2010-03-2012-02用CAG方案治疗的23例复发/难治性AML。结果：CLAG治疗的18例患者中,完全缓解（CR）率50%（9/18）,部分缓解（PR）率16.7%（3/18）,总有效率（OR）66.7%（12/18）。疗效与CAG方案相似。CLAG方案中,年龄≤30岁患者的CR率（65.1%）显著高于〉30岁组（44.6%）。而性别、外周血白细胞、骨髓原始细胞及细胞遗传学均不影响患者疗效。治疗前疾病状态也与临床疗效之间没有相关性。毒副作用主要为较强的骨髓抑制,其中粒细胞缺乏伴发热达88.9%（16/18）,而胃肠道反应和肝功能受损均为轻度。无化疗相关死亡。结论：CLAG方案治疗复发/难治性AML的近期疗效较好,特别适合年龄≤30岁的年轻患者。

Objective .. To evaluate the clinical effect and toxicity of CLAG regimen in treatment of refractory/ relapsed acute myeloid leukemia （AML）. Method ： Observation group.. From Mar, 2012 to Feb, 2014, 18 patients with refractory and relapsed AML were treated with CLAG regimen. Cladribine was given on d1-5 at a dose of 5 mg/m2 intravenously,arabinoside cytosine was given on d1-5 at a dose of 2 g/m2 intravenously, and G-CSF was given on d0-5 at a dose of 300μg. Control group：From Mar,2010 to Feb,2012,23 patients with refractory/re- lapsed AML were treated with CAG regimen. Result： Out of the 18 patients treated with CLAG regimen, 12 pa- tients （66.7%） showed responses..9 patients （50%） giving complete response （CR） and 3 patients （16.7%） partial response （PR）. The CR rate in patients under 30 years old was 65.1%, significantly higher than patients over 30 years old. The status before treatment wasn＇t relative with clinical response. Drug--related toxic effects of chemotherapy were severe bone marrow depression, mild gastrointestinal reactions and abnormal liver function. Conclusion：CI.AG regimen possesses moderate short term efficacy, acceptable toxicity, especially suitable for patients under 30 years old.