地西他滨联合微移植巩固治疗首次完全缓解老年急性髓系白血病的疗效与安全性分析

Comparison of the efficacy of decitabine combined with micro-transplantation or priming regimen as consolidation treatment for older patients with acute myeloid leukemia

目的探索老年急性髓系白血病（AML）第1次完全缓解（CR。）后采用地西他滨联合微移植巩固治疗的疗效与安全性。方法回顾性分析2012年11月至2015年9月诊治的37例CR，老年（≥60岁）AML患者病例资料，比较分析地西他滨联合微移植（微移植组，19例）与地西他滨联合预激方案巩固治疗（化疗组，18例）的疗效和不良反应。结果两组患者起病时的年龄、WBC水平、疾病状态差异均无统计学意义（P值均〉0．05）。两种巩固治疗方案的耐受性均良好，微移植组与化疗组的CTC3～4级非血液学不良反应发生率差异无统计学意义[36．8％（7／19）对27．8％（5／18），Х^2=0．347，P=0．728]。微移植组与化疗组中性粒细胞恢复的中位时间分别为12和13d（z=1．599，P=0．110），血小板恢复的中位时问分别为14和12d（z=-1.314，P=0．189）。微移植组患者均未发生移植物抗宿主病。微移植组与化疗组的2年无白血病生存率分别为50．7％和24．3％（P=0．047），2年总生存率分别为54．9％和30．0％（P=0．071）。结论对于老年AML患者，地西他滨联合微移植可能是一种安全有效的巩固方案。

Objective To probe the feasibility of decitabine （DAC） combined with micro- transplantation as consolidation treatment for older patients with acute myeloid leukemia （AML）. Methods Between November 2012 and September 2015, 37 consecutive patients with AML 1〉60 years of age were analyzed. Of them, 19 patients received consolidation therapy with DAC followed by micro- transplantation （mierotransplant group）. Another 18 ones （chemo group） were treated with DAC plus priming regimen as consolidation chemotherapy in the same period. Results There were no significant differences in terms of age, WBC count, and disease status of onset between the microtransplant and chemo groups （P 〉 0.05）. The two regimens were well tolerated. There was no difference of CTC grade 3-4 nonhematologic toxicities between the microtransplant and chemo groups （36.8% vs 27.8%, Z2 = 0.347, P = 0.728）. The median recovery durations for neutrophil and platelet in the microtransplant group were similar to those in the chemo group （12 vs 13 days, z = 1.599, P = 0.110; 14 vs 12 days, z=-1.314, P= 0.189, respectively）. No graft-versus-host disease was observed in the microtransplant group. The 2- year leukemia-free survival and overall survival were better in microtransplant group （50.7% and 54.9%, respectively） than in chemo group （24.3% and 30.0%, respectively） （P = 0.047 and P = 0.071, respectively）. Conclusion DAC combined with micro-transplantation as a consolidation regimen may be a safe and promising option for older patients with AML.