DCAG方案治疗复发难治性急性髓系白血病的效果与预后影响因素分析

The clinical efficacy and prognosis of DCAG regimen on relapsed and refractory acute myeloid leukemia

目的观察DCAG化疗方案治疗复发难治性急性髓系白血病(AML)的临床效果及影响因素。方法选取60例AML并接受DCAG化疗方案的患者为观察组,选取同期50例复发难治性AML并接受CAG化疗方案的患者为对照组。对照组给予CAG化疗方案。观察组在此基础上加用地西他滨(DCAG)方案。两组患者用药均4周1个疗程,治疗2个疗程。比较两组患者的临床疗效及安全性,探讨其疗效影响因素。结果治疗后观察组总有效率(TR)为65.00%,高于对照组的46.00%(P<0.05)。随访后观察组中位无进展生存期(PFS)、中位总生存期(OS)均较对照组延长(P<0.05)。单因素分析显示,发病年龄、用药依从性、血液不良反应、治疗前病程、初始白细胞和血小板、骨髓原始细胞比例与患者TR有关(P<0.05)。DCAG治疗中,皮肤痤疮样不良反应发生率为38.33%,与对照组相比差异有统计学意义(P<0.05)。结论 DCAG化疗治疗复发难治性AML疗效显著,不良反应可耐受,年龄、用药依从性、血液不良反应、治疗前病程、初始白细胞和血小板、骨髓原始细胞比例可能是影响疗效及生存预后的因素。

Objective To observe the efficacy and influencing factors of DCAG chemotherapy on relapsed and refractory myeloid leukemia. Methods From January 2015 to January 2018, 60 patients with relapsed acute myeloid leukemia(AML), who received DCAG chemotherapy, were enrolled in the observation group. 50 patients with recurrence and refractory disease were selected in our hospital. Patients with AML who underwent CAG chemotherapy were included in the control group. The control group was given with CAG chemotherapy regimen. The observation group received additional decitabine(DCAG) treatment. The clinical efficacy and safety were compared, and the factors influencing the efficacy were discussed. Results The total effective rate(TR) of the observation group was 65.00%, significantly higher than that of the control group(46.00%, P<0.05). After the follow-up, the median progression-free survival(PFS) and median overall survival(OS) of the observation group were significantly longer than those of the control group(P<0.05). Univariate analysis showed that age of onset, medication compliance, adverse blood reactions, pre-treatment course, initial WBC and PLT, and percentage of bone marrow blasts were associated with TR(P<0.05). The incidence of skin acne-like adverse reactions in DCAG treatment was 38.33%, which was significantly different from the control group(P<0.05). Conclusion DCAG chemotherapy is effective in the treatment of relapsed and refractory myeloid leukemia. The adverse reactions can be tolerated. Age, medication compliance, adverse blood reactions, pre-treatment course, initial WBC and PLT, and the ratio of bone marrow blasts may affect the efficacy and survival prognosis. factor.