阿米福汀联合地西他滨及CHG方案治疗高危骨髓增生异常综合征的疗效观察

Effect of amifostine combine with decltabine and CHG regimen on high-risk myelodysplastic syndrome

目的：观察阿米福汀联合地西他滨及CHG方案（阿糖胞苷＋羟基喜树碱＋重组人粒细胞刺激因子）治疗高危骨髓增生异常综合征（MDS）的疗效。方法：将42例高危MDS患者随机分为2组,第1组应用小剂量地西他滨及CHG方案治疗（19例）,第2组应用阿米福汀联合地西他滨及CHG方案治疗（23例）,14 d为1个周期,治疗2个周期后评估疗效,观察不良反应发生情况。结果：阿米福汀联合地西他滨及CHG方案治疗组总有效率与地西他滨及CHG方案组比较差异无统计学意义（78.3%∶78.9%,P〉0.05）。近期死亡率方面,阿米福汀联合地西他滨及CHG方案治疗组明显低于地西他滨及CHG方案治疗组（0∶15.8%,P〈0.05）;Ⅲ-Ⅳ度白细胞减少和血小板减少发生率方面,阿米福汀联合地西他滨及CHG方案组明显低于地西他滨及CHG方案组（21.7%∶36.8%,69.6%∶89.5%,P〈0.05）;黏膜炎的发生率方面,阿米福汀联合地西他滨及CHG方案组明显低于地西他滨及CHG方案组（17.4%∶42.1%,P〈0.05）。结论：阿米福汀联合地西他滨及CHG方案治疗中高危MDS安全有效,其近期死亡率降低,Ⅲ~Ⅳ度血液学毒性及黏膜炎等不良反应明显减轻。

Objective： To observe the effect of amifostine combine with decltabine and CHG regimen（ cytarabine ＋hydroxycamptothecin ＋ recombinant human granulocyte colony stimulating factor） on high-risk myelodysplastic syndrome（ MDS）. Method： Forty-two patients with high-risk MDS were randomly divided into two groups. Patients in the first group were used decltabine and CHG regimen,and patients in the second group were used amifostine with decltabine and CHG regimen. Fourteen days for 1 cycle,the efficacy was evaluated after 2 cycles of treatment,and the occurrence of adverse events were observed. Result： There was no significant difference in the total effective rate between amifostine with decltabine-CHG regimen and decltabine-CHG regimen（ 78. 3% vs. 78. 9%,P〉0. 05）. Recent mortality was significantly lower in amifostine with decltabine-CHG regimen than that in decltabine-CHG regimen（ 0 vs. 15. 8%,P〈0. 05）. The incidences of grade 3 to 4 neutropenia and thrombocytopenia were significantly lower in amifostine with decltabine-CHG regimen than those in decltabine-CHG regimen（ 21. 7% vs. 36. 8%,69. 6% vs. 89. 5%,P〈0. 05）. The incidence of mucositis was significantly lower in amifostine with decltabine-CHG regimen than that in decltabine-CHG regimen（ 17. 4%vs. 42. 1%,P〈0. 05）. Conclusion： Amifostine with decltabine-CHG regimen is safe and effective,with lower recent mortality and grade 3 to 4 hematologic toxicity and mucositis.