地西他滨联合减量CTG方案治疗中高危骨髓增生异常综合征和急性髓细胞白血病的临床应用

Decitabine combined with dose reduced CTG for high risk MDS and AML

目的探讨国产地西他滨联合减量[粒细胞集落刺激因子(G-CSF)+吡柔比星(THP)+阿糖胞苷(Ara-C)](CTG方案)治疗中高危骨髓增生异常综合征(MDS)和急性髓细胞白血病(AML)的疗效、安全性和影响疗效的相关因素。方法收集2014年5月至2015年6月东莞市人民医院血液科收治的21例中高危MDS和AML患者的临床资料,应用国产地西他滨联合减量CTG方案治疗。结果21例患者中,完全缓解者7例,PR者8例,治疗失败者6例,总有效率为71.4%。1例死亡(4.8%)。所有患者在治疗过程中均出现不同程度的骨髓抑制,第1、2个疗程的粒缺持续时间、Ⅳ度血小板减少持续时间差异无统计学意义(P>0.05),感染的发生率差异也无统计学意义(P>0.05),高龄患者骨髓抑制时间更长,不良反应更严重,所有患者非血液学不良反应均可耐受。单因素分析结果显示,自发病至接受去甲基化药物治疗时间低于半年者、第1个疗程后血小板计数较基础值提高的患者,疗效较好,预后基因FLT3阳性患者疗效不佳。患者的年龄、性别和是否存在染色体核型异常与疗效无显著相关性。结论国产地西他滨联合减量CTG方案可有效地治疗MDS和AML,能够降低肿瘤负荷,抑制不良反应,主要不良反应为骨髓抑制和感染。

Objective To investigate the clinical efficacy and adverse events of domestically produced decitabine combined with dose reduced CTG [granulocyte colony stimulating factor（ G-CSF）,pirarubicin（ THP） and arabinosyl cytosine（ Am-C） ]regimen for moderate to high risk myelodysplastic syndrome（ MDS） and acute myeloid leukemia（ AML） and factors influencing efficacy were also examined. Methods A total of 21 patients with moderate to high risk MDS and AML treated in Dongguan People＇s Hospital from May 2015 to June 2016 were included. Patients received domestically produced decitabine combined with dose reduced CTG regimen. Results Seven patients achieved complete remission. Eight patients achieved partial remission. Treatment failure occurred in 6 patients and the total efficiency rate was 71. 4%.One patient died and the overall mortality was（ 4. 8%）. Various degrees of myelosuppression occurred in all patients during the process of treatment. There was no statistically significant difference in the duration of agranulocytosis in the 1 and 2 cycles of treatment and the duration of grade Ⅳ thrombocytopenia（ P〉0. 05）. There was no statistical significant difference in the incidence of infection too（ P〉0. 05）. Duration of myelosuppression was relatively longer and serious adverse effects were relatively higher in elderly patients. All patients can withstand non hematologic adverse reactions. Univariate analysis showed that relatively better efficacy can be found in patients whose mediation time was less than six months from disease onset to receiving demethylating agents and patients whose platelet count increased after a course of treatment compared with baseline. Those with FLT3 positive had poor efficacy. Age and gender with or without chromosome disorders were not significantly associated with the efficacy. Conclusion Domestically produced decitabine combined with dose reduced CTG regimen can actively and effectively treat MDS and AML. It can reduce tumor burden with controllable adverse effects. The major side effects were myelosuppression and infection.