两种含G-CSF预激的化疗方案治疗复发难治性急性髓系白血病的疗效比较

Comparison of the efficacy of two G-CSF pre-excitation chemotherapy regimens in treating relapsed-refractory acute myeloid leukemia

目的比较改良FLAG与CAG两种含G-CSF预激的化疗方案对复发难治性急性髓系白血病(AML)的疗效及安全性。方法回顾分析56例复发难治性AML患者的临床资料,按化疗方案将患者分为改良FLAG组(25例)和CAG组(31例),比较两组的疗效及不良反应。结果改良FLAG组完全缓解(CR)16例(64.0%),部分缓解(PR)2例(8.0%),总有效率(OR)为72.0%(18/25),CAG组CR 16例(51.6%),PR 3例(9.7%),OR为61.3%(19/31),两组总有效率比较无统计学差异(P>0.05)。但难治组中改良FLAG方案的CR及OR率均较CAG组高(P<0.05),CR分别为64.7%(11/17)与23.5%(4/17),OR分别为70.6%(12/17)与41.2%(7/17)。两组患者的主要不良反应为骨髓抑制、感染,两组在并发感染、出血、肝脏及心脏毒性等不良反应发生率方面无统计学差异。结论改良FLAG方案和CAG方案疗效相近,不良反应可耐受,均为复发难治性AML的有效治疗方案。但改良FLAG方案对难治性AML患者疗效优于CAG方案。

Objective To compare the efficacy and safety of modified FLAG and CAG-containing G-CSF regimens in the treatment of recurrent refractory acute myeloid leukemia（AML）. Methods The clinical data of 56 patients with recur- rent refractory AML were retrospectively analyzed and the patients were divided into modified FLAG group（n=25） and CAG group（n=31） according to the chemotherapy regimen. The curative effect and adverse reactions between the two groups were compared. Results There were 16 cases of complete remission（CR, 64.0%）, 2 cases of partial response（PR, 8.0%） in the modified FLAG group, with total effective rate（OR） of 72.0%（18/25）. There were 16 cases of CR（51.6%） and 3 cases of PR （9.7%） in the CAG group, with OR of 61.3%（19/31）. There was no significant difference in the total effective rate between the two groups（P〉0.05）. But the CR rate of 64.7%（11/17） and OR rate of 70.6%（12/17） of the modified FLAG regimen in refractory group were higher than those in CAG group[23.5%（4/17） and 41.2%（7/17）, P〈0.05]. The major adverse reactions in both groups were myelosuppression and infection. There was no significant difference in the incidence of adverse reactions such as infection, hemorrhage, liver and cardiotoxicity between the two groups. Conclusion The modified FLAG regimen and CAG regimen are similar in efficacy and tolerable adverse reactions, and both are effective regimens for relapsed AML. However, the effect of modified FLAG regimen on refractory AML patients is better than that of CAG regimen.