小剂量地西他滨序贯减量CAG方案治疗中高危骨髓增生异常综合征疗效观察

Clinical outcome of ultra low-dose decitabine combined with reduced-intensity CAG therapeutic regimen on intermediate or high risk myelodysplastic syndrome

目的回顾性分析超低剂量地西他滨(decitabine,DAC)序贯减量CAG方案治疗中高危骨髓增生异常综合征(myelodysplastic syndrome,MDS)的近期临床疗效及安全性。方法收集本院血液科2015年4月-2016年10月收治的30例中高危骨髓增生异常综合征患者,其中男23例,女7例,中位年龄61(50~81)岁,均接受超低剂量DAC序贯减量CAG方案治疗,观察临床疗效、不良事件和生存时间。结果 30例中16例(53%)获完全缓解(complete remission,CR),5例(17%)获部分缓解(partial remission rate,PR),3例(10%)获血液学改善(hematological improvement,HI),6例(20%)治疗无效(total failure,TF),总反应率(overall response rate,ORR)为80%;中位生存时间11(2~18)个月,24例存活,6例死亡。15例(50%)治疗中出现感染,其中2例(7%)重症感染。结论超低剂量DAC序贯减量CAG方案治疗中高危MDS老年患者疗效稳定,重症感染及血液学不良反应发生率低,耐受性好,提示可在临床进一步推广。

Objective To observe the clinical outcome and safety of ultra low-dose of decitabine （DAC） combined with reduced- intensity CAG （aclacinomycin, cytarabine, granulocyte colony stimulating factor） therapeutic regimen on intermediate or high risk myelodysplastic syndrome （MDS）. Methods Total of 30 patients treated by ultra low-dose DAC combined with reduced-intensity CAG therapeutic regimen in our center from Apr. 2015 to Oct. 2016 were included in this study, and the clinical outcome, adverse reactions, and survival data were recorded. Results Of all the patients, complete remission （CR） rate was 53% （16 cases）, partial remission rate （PR） was 17% （5 cases）, hematological improvement （HI） rate was 10% （3 cases）, total failure （TF） was 20% （6 cases） and overall response rate （ORR） was 80%. Infection was the main adverse event caused by DAC and occurred in 15 patients （50%）, with 2 of them severely infected. The median survival time was 11 months （2-18 months） with 24 survived and 4 died. Conclusion Ultra low-dose DAC combined with reduced-intensity CAG therapeutic regimen is effective and safe on intermediate or high risk MDS with lower rate of severe infection and hematological toxicities.