地西他滨联合足量长疗程预激方案治疗复发难治急性髓系白血病32例临床研究

Decitabine combined with full-dose and long-term pre-excitation regimen for treatment of relapsed/refractory acute myeloid leukemia:a clinical study of 32 cases

目的观察地西他滨联合足量长疗程预激方案诱导缓解治疗复发难治急性髓系白血病(AML)的临床疗效及不良反应。方法收集2013年5月至2018年2月河南省肿瘤医院收治的32例复发难治AML患者,采用地西他滨联合预激方案治疗。其中15例采用地西他滨联合CAG预激方案治疗,17例采用地西他滨联合CHAG预激方案治疗,具体为:地西他滨25mg,静脉滴注,第1天至第3天;阿糖胞苷10~15 mg/m^2,静脉滴注,每12 h 1次,第4天至第17天或更长;高三尖杉酯碱1 mg/m^2,静脉滴注,第4天至第10天或更长;阿柔比星8~10 mg/m^2,静脉滴注,第4天至第11天或更长;粒细胞集落刺激因子100~200 μg/m^2,皮下注射,化疗前1 d开始,根据血象调整。观察疗效和患者不良反应。结果32例患者中完全缓解(CR)29例(90.6%),部分缓解(PR)3例(9.4%),总反应(CR+PR)率为100.0%(32/32)。地西他滨联合CAG方案组CR 13例,地西他滨联合CHAG方案组CR 16例,两组患者疗效差异无统计学意义(P=0.589)。患者主要不良反应为粒细胞缺乏、血小板减少、继发感染及发热等,无严重不良反应发生。

Objective To observe the clinical efficacy and adverse events of decitabine combined with full-dose and long-term pre-excitation regimen as a induction therapy for relapsed/refractory acute myeloid leukemia (AML).Methods A total of 32 patients with relapsed/refractory AML in Henan Provincial Cancer Hospital from May 2013 to February 2018 were enrolled.All the patients were treated with decitabine combined with full-dose and long-term pre-excitation regimen,including 15 patients who received decitabine combined with CAG regiemtn,and 17 patients who received decitabine combined with CHAG regimen: 25 mg decitabine,intravenous drip,from day 1 to day 3;cytarabine (10-15 mg/m^2) administered subcutaneously every 12 h one time,from day 4 to day 17 or more;homoharringtonine (1 mg/m^2) intravenous drip,administered intravenously from day 4 to day 10 or more;aclacinomycin (8-10 mg/m^2),intravenous drip,administered intravenously from day 4 to day 11 or more;granulocyte colony-stimulating factor (G-CSF)(100-200 μg/m^2),subcutaneous injection,and it began 1 day before chemotherapy,adjusted according to the blood cell count;the therapeutic effect and adverse reactions of the patients were observed.Results There were 29 patients (90.6%) with complete remission (CR),3 patients (9.4%) with partial remission (PR),and the overall response (CR+PR) rate was 100.0%(32/32).In decitabine combined with CAG regimen group,13 patients achieved CR;in decitabine combined with CHAG regimen group,16 patients achieved CR,and there was no statistically significant difference in the efficacy between the two groups (P=0.589).The main adverse reactions were agranulocytosis,thrombocytopenia,secondary infection and fever,and no serious adverse events occurred.Conclusion Decitabine combined with full-dose and long-term pre-excitation regimen has a favorable efficacy and safety,which provides a new therapy for relapsed/refractory AML.