沙利度胺、司坦唑醇联合泼尼松用于改善骨髓纤维化患者芦可替尼治疗相关血液学不良反应

Thalidomide, stanozolol combined with prednisone for improvement of the related hematologic adverse reactions of ruxolitinib in patients with myelofibrosis

目的分析沙利度胺、司坦唑醇、泼尼松联合（TSP方案）治疗骨髓纤维化（MF）患者芦可替尼治疗相关血液学不良反应的效果及安全性。 方法回顾性分析2016年1月至2017年7月北京协和医院芦可替尼治疗中出现贫血和（或）血小板减少的10例MF患者临床资料，所有患者接受低剂量沙利度胺（约75 mg/d）、司坦唑醇（2 mg/次，3次/d）和小剂量泼尼松（每天0.5 mg/kg）联合治疗，评估其血液学不良反应及安全性。 结果服用芦可替尼过程中，出现贫血和血小板减少者分别为9例和7例。采用TSP方案治疗后，血红蛋白有效5例，其中1例获得完全缓解（CR）；血小板有效4例，均为CR。合计血液学指标总有效7例。开始服药至起效中位时间为27 d（13～89 d）。起效的7例患者中有3例疗效丧失，疗效持续中位时间为未达到（28～207 d）。结论TSP方案可以改善MF患者芦可替尼治疗中出现的贫血和血小板减少症。

ObjectiveTo analyze the clinical effects and safety of combination treatment of thalidomide, stanozolol, and prednisone （TSP regimen） in patients with myelofibrosis （MF） who experienced hematological adverse reactions during ruxolitinib treatment.MethodsTen MF patients with anemia or thrombocytopenia during ruxolitinib treatment from January 2016 to July 2017 in Peking Union Medical College Hospital were retrospectively analyzed. All patients were treated with a combination of low dose of thalidomide （around 75 mg/d）, stanozolol （2 mg/time, 3 times per day）, and low dose of prednisone （0.5 mg·kg-1·d-1）. The hematological response and safety were assessed.ResultsThere were 9 cases of anemia and 7 cases of thrombocytopenia during ruxolitinib treatment. After TSP regimen treatment, there were 5 cases of hemoglobin response including 1 case of complete remission （CR）. There were 4 cases of platelet response and all achieved CR. Totally, the hematological overall response was seen in 7 cases. The median time from taking medicine to getting response was 27 d （13-89 d）. 3 patients lost efficacy, while the median duration of response didn＇t reach （28-207 d）.ConclusionTSP regimen can improve anemia or thrombocytopenia during ruxolitinib treatment in patients with MF.