地西他滨联合三氧化二砷治疗老年急性髓系白血病的疗效及安全性

Evaluation of the efficacy and safety of decitabine combined with arsenic trioxide in the treatment of senile acute myeloid leukemia

目的探讨地西他滨联合三氧化二砷治疗老年急性髓系白血病(非急性早幼粒细胞白血病)的临床效果及安全性。方法选择2016年2月至2018年10月新乡市中心医院收治的54例老年急性髓系白血病患者为研究对象,根据治疗方法分为观察组和对照组,每组27例。观察组患者给予地西他滨和三氧化二砷联合治疗,对照组患者给予高三尖杉酯碱和盐酸阿糖胞苷联合治疗;2组患者分别于治疗前及治疗2个周期后检测白细胞计数(WBC)、红细胞计数(RBC)、血小板计数(BPC)及血红蛋白(HGB)水平,并对2组患者的临床疗效及不良反应发生率进行比较。结果观察组患者完全缓解17例,部分缓解6例,未缓解3例,总有效率为85.19%(23/27);对照组患者完全缓解14例,部分缓解10例,未缓解3例,总有效率为88.89%(24/27),2组患者总有效率比较差异无统计学意义(χ^2=1.351,P>0.05)。治疗前2组患者WBC、RBC、BPC及HGB水平比较差异均无统计学意义(P>0.05)。对照组患者治疗后WBC、BPC及HGB水平显著高于治疗前(P<0.05),但对照组患者治疗前后RBC比较差异无统计学意义(P>0.05);观察组患者治疗后WBC、RBC、BPC及HGB水平显著高于治疗前(P<0.05)。治疗后,观察组患者WBC、RBC、BPC及HGB水平显著高于对照组(P<0.05)。观察组患者中性粒细胞减少、严重感染、严重出血及胃肠道反应发生率分别为33.33%(9/27)、25.93%(7/27)、14.81%(4/27)、7.41%(2/27),对照组患者中性粒细胞减少、严重感染、严重出血及胃肠道反应发生率分别为100.00%(27/27)、74.07%(20/27)、70.37%(19/27)、100.00%(27/27);观察组患者中性粒细胞减少、严重感染、严重出血及胃肠道反应发生率显著低于对照组(χ^2=5.035、7.619、7.932、7.881,P<0.05)。结论地西他滨联合三氧化二砷治疗老年急性髓系白血病(非急性早幼粒细胞白血病)疗效肯定,且不良反应发生率低,安全性较好。

Objective To investigate the clinical effect and safety of decitabine combined with arsenic trioxide in the treatment of senile acute myeloid leukemia(non-acute promyelocytic leukemia).Methods A total of 54 elderly patients with acute myeloid leukemia admitted to Xinxiang Central Hospital from February 2016 to October 2018 were selected as the study objects.They were divided into observation group and control group according to the treatment methods,with 27 cases in each group.The patients in the observation group were treated with decitabine and arsenic trioxide,while the patients in the control group were treated with homoharringtonine and cytarabine hydrochloride.The white blood cell count(WBC),red blood cell count(RBC),platelet count(BPC)and hemoglobin(HGB)level of patients in the two groups were detected before treatment and after two cycles of treatment.The clinical effect and the incidence of adverse reactions were compared between the two groups.Results In the observation group,there were 17 cases of complete remission,6 cases of partial remission and 3 cases of non remission,the total effective rate was 85.19%(23/27).In the control group,there were 14 cases of complete remission,10 cases of partial remission and 3 cases of non remission,the total effective rate was 88.89%(24/27).There was no significant difference in the total effective rate between the two groups(χ^2=1.351,P>0.05).There was no significant difference in WBC,RBC,BPC and HGB levels between the two groups before treatment(P>0.05).The WBC,BPC and HGB levels after treatment were significantly higher than those before treatment in the control group(P<0.05);there was no significant difference in RBC before and after treatment in the control group(P>0.05).The WBC,RBC,BPC and HGB levels after treatment were significantly higher than those before treatment in the observation group(P<0.05).After treatment,the WBC,RBC,BPC and HGB levels in the observation group were significantly higher than those in the control group(P<0.05).The incidence of neutropenia,severe infection,severe bleeding and gastrointestinal reaction in the observation group was 33.33%(9/27),25.93%(7/27),14.81%(4/27)and 7.41%(2/27),respectively;the incidence of neutropenia,severe infection,severe bleeding and gastrointestinal reaction in the control group was 100.00%(27/27),74.07%(20/27),70.37%(19/27)and 100.00%(27/27),respectively.The incidences of neutropenia,severe infection,severe bleeding and gastrointestinal reaction in the observation group were significantly lower than those in the control group(χ^2=5.035,7.619,7.932,7.881;P<0.05).Conclusion Decitabine combined with arsenic trioxide in the treatment of senile acute myeloid leukemia(non-acute promyelocytic leukemia)is effective,and the incidence of adverse reactions is low and the safety is good.