地西他滨联合化学治疗对中高危慢性粒单核细胞白血病的疗效分析

Clinical efficacy of decitabine combined with chemotherapy in treatment of intermediate-and high-risk chronic myelomonocytic leukemia

目的探讨地西他滨联合化学治疗对中高危慢性粒单核细胞白血病(CMML)的疗效。方法分析接受地西他滨联合化学治疗的21例中高危CMML患者临床资料,总结疗效。结果21例患者中男15例、女6例,年龄48(21～72)岁,CMML特异性预后评估系统(CPSS)危险评分均为中高危。接受地西他滨联合化学治疗第1疗程后16例(76.2%)患者获得完全缓解,1例(4.8%)患者获得骨髓完全缓解,第1疗程总反应率为81.0%,无治疗相关死亡患者。21例随访时间18(2～55)个月,中位生存时间17.6个月。11例年龄43(21～53)岁的患者在接受中位疗程为3个疗程的联合方案治疗后进行了异基因造血干细胞移植,随访时间7～55个月,中位生存时间18个月,移植后复发率9.1%(1/11)。结论地西他滨联合化学治疗可使中高危CMML患者获得较高的完全缓解率,且患者耐受性良好。

Objective To evaluate the clinical efficacy and safety of decitabine combined with chemotherapy in the treatment of intermediate-and high-risk chronic myelomonocytic leukemia(CMML). Methods Clinical data of 21 patients with intermediate-and high-risk CMML who received decitabine combined chemotherapy were retrospectively analyzed. Clinical efficacy and safety were assessed. Results Among 21 patients, 15 cases were male and 6 female, aged 48 years on average(range, 21-72 years). All patients were classified as intermediate-and high-risk CMML according to the CMML-specific prognostic scoring system(CPSS). Sixteen patients(76.2%) achieved complete remission(CR) and 1(4.8%) had marrow CR(mCR) after one course of decitabine combined with chemotherapy, with an overall response rate(ORR) of 81.0%. No treatment-related death was observed. The average follow-up duration was 18 months(range, 2 to 55 months). The median overall survival was 17.6 months. Eleven patients with a median age of 43 years(range, 21-53 years) received allogeneic hematopoietic stem cell transplantation(allo-HSCT) after three courses of joint regimen. They were followed up for 7-55 months. The median overall survival was 18 months. The recurrence rate was 9.1% after allo-HSCT(1/11). Conclusions Decitabine combined with chemotherapy yields relatively high CR rate and excellent tolerance for patients with intermediate-and highrisk CMML.