地西他滨联合预激方案治疗急性髓系白血病效果观察

Clinical efficacy of decitabine combined with HAG or HAG-like regimen in treatment of acute myeloid leukemia

目的 观察地西他滨联合预激方案治疗初诊与复发难治急性髓系白血病（AML）的效果.方法 回顾性分析2014年1月至2017年12月在宁波大学医学院附属鄞州医院接受地西他滨联合预激方案诱导治疗的31例AML患者对地西他滨联合预激方案的治疗反应.其中初诊AML 18例,复发难治AML 13例.结果 初诊患者对地西他滨联合预激方案治疗的总体反应率（ORR）达77.8％（14/18）,其中完全缓解（CR）/血细胞计数未完全恢复的完全缓解（CRi） 13例,1年总生存（OS）率为39.2％,1年无病生存（DFS）率为32.5％;复发难治患者ORR为53.8 ％（7/13）,其中CR/CRi6例,1年OS率为22.4％,1年DFS率为7.7％.共有11例患者由骨髓增生异常综合征（MDS）转化,其ORR为90.9％（10/11）,其中CR/CRi 9例,1年OS率为63.8％,1年DFS率为37.5％.治疗不良反应主要为骨髓抑制所致的感染和出血,非血液学不良反应主要为胃肠道反应及肝损害.经抗感染及支持治疗后,31例患者均安全度过骨髓抑制期,无一例发生治疗相关死亡.结论 地西他滨联合预激方案是骨髓低增生性的初诊及复发难治AML安全有效的诱导治疗手段,对MDS转化的AML疗效更好.

Objective To explore the clinical efficacy of decitabine combined with HAG or HAG-like regimen for newly diagnosed and relapsed/refractory acute myeloid leukemia （AML） patients.Methods Thirty-one newly diagnosed （18 cases） and relapsed/refractory （13 cases） AML patients receiving decitabine combined with HAG or HAG-like regimen in Yinzhou Hospital Affiliated to Medical School of Ningbo University from January 2014 to December 2017 were analyzed retrospectively.Results The outcome of 18 newly diagnosed AML patients showed that the overall response rate （ORR） was 77.8 % （14/18）,including 13 patients achieved complete response （CR） / CR with incomplete blood count recovery （CRi）,and the 1-year overall survival （OS） rate was 39.2 %,the l-year disease free survival （DFS） rate was 32.5 %.The outcome of 13 relapsed/refractory AML patients showed that the ORR was 53.8 % （7/13）,including 6 patients achieved CR/CRi,and the 1-year OS rate was 22.4 %,the 1-year DFS rate was 7.7 %.Eleven patients were transformed from myelodysplastic syndromes （MDS）,the ORR was 90.9 % （10/11）,including 9 patients achieved CR/CRi,and the 1-year OS and DFS rates were 63.8 % and 37.5 % respectively.The main adverse events of infection and bleeding were caused by myelosuppression,and non-hematological toxicity included gastrointestinal and liver dysfunction.After the anti-infection and supportive treatment,all 31 patients were safely through bone marrow suppression,with no treatment-related deaths.Conclusions Decitabine combined with HAG or HAG-like regimen is an effective and safe treatment strategy for hypoplastic newly diagnosed and relapsed/refractory AML patients.It is produced relatively higher curative effect for AML patients with MDS transformation.