地西他滨联合半量CAG方案治疗骨髓增生异常综合征-伴原始细胞增多和急性髓细胞白血病的疗效分析

Clinical efficacy of decitabine combined with half of one course of CAG regimen for myelodysplastic syndromes with excess blasts and acute myeloid leukemia

目的:比较地西他滨(DAC)联合半程粒细胞集落刺激因子(G-CSF)联合小剂量阿糖胞苷(Ara-C)及阿克拉霉素(Acla)的预激化疗方案(CAG)与CAG方案治疗骨髓增生异常综合征伴原始细胞增多(MDS-EB)和急性髓系白血病(MDS/AML)患者的临床疗效及安全性。方法:回顾性分析21例MDS/AML患者临床资料,12例接受DAC-CAG(D-CAG)方案,9例接受CAG方案,诱导缓解后患者继续巩固化疗或进行造血干细胞移植。比较2组患者的总反应率(0RR)、总生存率(0S)及不良反应发生率。结果:2组的ORR分别为83.3%和66.7%,差异无统计学意义(P>0.05)。13例存活,6例死亡,2例失访,中位随访时问9(5~46)个月。2组2年OS率分别为66.7%、和55.6%,差异无统计学意义(P>0.05)。2组患者在治疗后,感染发生率、出血发生率、平均粒细胞缺乏时间、平均红细胞输注量、平均血小板输注量差异均无统计学意义(均P>0.05)。经抗感染及支持治疗后,21例患者均安全度过骨髓抑制期,无一例死亡。结论:D-CAG及CAG方案治疗MDS/AML均有较好的疗效,D-CAG方案诱导治疗有效率相对较高,不良反应与CAG方案相当,对患者长期生存的影响有待进一步观察。

Objective: To evaluate the clinical efficacy and safety of decitabine in combination with half of one course of CAG regime (G-CSF, cytarabine and aclarubicin;D-CAG regimen) or standard CAG regimen in the treatment of myelodysplastic syndromes with excess blasts (MDS-EB) and acute myeloid leukemia (AML). Methods: Totally 21 patients with MDS/AML were included in the retrospective study. Nine cases were initially treated with cytarabine (10 mg/m 2, q12h for 14 days), aclarubicin (20 mg/day for 4 days) and G-CSF (300μg/day)(CAG regimen). The rest 12 cases were initially treated with decitine (20 mg/m 2 for 5 days) and lower-dose CAG regimen (cytarabine: 10 mg/m 2 q12h for 7 days, aclarubicin: 10 mg/day for 4 days, and G-CSF: 300μg/day)(D-CAG regimen). After two cycles of induction chemotherapy, the patients who obtained complete remission (CR) received consolidation chemotherapy or hematopoietic stem cell transplantation (HSCT). Complete remission (CR) rate, overall response rate (ORR) and overall survival (OS) were observed in the two groups. Meanwhile, the factors relevant to decitabine efficacy and the prognosis were analyzed. Results: ORR in the two groups was 83.3% and 66.7% respectively with no statistically significant differences ( P >0.05). At the last follow-up in Dec. 31, 2018, 13 patients still survived, 6 died, and 2 lost follow-up. The 2-year survival rate in the two groups was 66.7% and 55.6% respectively with no statistically significant differences ( P >0.05). There were no statistically significant differences ( P >0.05) in the two groups in terms of infection rate, bleeding rate, duration of neutrophenia, mean MAP transfusion and mean platelet transfusion. All 21 patients safely passed through bone marrow suppression by anti-infective and supportive treatment without treatment-related deaths. Conclusions: Treating MDS/AML with D-CAG regimen produced high efficacy. ORR of the D-CAG regimen was relatively higher, and was a promising choice.