地西他滨联合CAG方案治疗老年急性髓系白血病疗效观察

Decitabine combined with chemotherapy CAG regime versus IA regime for elderly patients with acute myeloid leukemia

目的比较地西他滨联合CAG方案与标准IA方案治疗老年急性髓系白血病患者的临床疗效及安全性。方法回顾性分析20例接受地西他滨联合CAG方案、23例接受IA方案治疗的初发老年AML患者的临床资料,分别比较两组患者的总反应率（ORR）、总生存率（OS）及不良反应发生率。结果 43例患者的ORR为58.14%,地西他滨联合CAG组及IA组的ORR分别为65%、52.2%,两组比较差异无统计学意义（P〉0.05）。截至2015年8月31日,16例存活,25例死亡,2例失访,中位随访时间10（1-34）个月,2年OS率为11.63%,两组1年OS率分别为50%、39.13%,差异无统计学意义（P〉0.05）。39例患者出现感染,25例有出血,两组患者在感染发生率、出血发生率差异无统计学意义。两组的红细胞输注量分别为5.35 U、8.30 U,单采血小板输注量分别为1.85 U、3.48 U,差异有统计学意义（P〈0.05）。结论地西他滨联合CAG方案和IA方案治疗老年AML患者均有较好的疗效,地西他滨联合CAG方案CR率及OR率相对较高。两组治疗副反应相当,但地西他滨联合CAG组骨髓造血恢复较快。

Objective To compare the clinical safety and efficacy of decitabine combined with chemotherapy CAG regime to IA regime in treatment of elderly patients with acute myeloid leukemia（AML）.Methods Forty three elderly AML patients were treated with combination of decitabine（15 mg /m^2× 3 d） and CAG chemotherapy（CAG group,n = 20）（Acla 20 mg × 3 d,Ara-C 10 mg q12 h d1-14,G-CSF 100 μg / d d1-14） or IA chemotherapy（IA group,n = 23）（Idarubicin 5 mg / m^2d1-3,Ara-C 100 mg / m^2d1-7）.The complete remission（CR） rate,overall response rate（ORR） and overall survival（OS） of the two groups were documented.The factors related to decitabine efficacy and the prognosis was analyzed.Results ORR in CAG and IA groups were 65% and 52.2%,respectively（P〉0.05）.The 2-year cumulative survival rate was 11.63%.The 1-year survival rate of two groups were 50% and 39.1%,respectively（P〉0.05）.Infection occurred in 39 patients and bleeding events occurred in 25 patients;there were no significant difference in rate of infection and bleeding events between two groups（P〉0.05）.The mean M AP transfusion platelet transfusion in CGA group were lower than those in IA group（5.35 U vs 8.30 U and 1.85 U vs 3.48 U,P〈0.05）.Conclusion Decitabine combination with CAG and IA chemotherapy produced high efficacy and lowadverse effects for elderly AM L patients.In decitabine combination with CAG regime the ORR and CR are relatively higher,and the hemopoiesic function is recovered earlier.