地西他滨和沙利度胺两种方案治疗骨髓增生异常综合征的临床疗效

Therapeutic Effects of Decitabine and Thalidomide plus Dexamethasone for Myelodysplastic Syndrome

目的评价云南省第一人民医院血液科2017年7月至2018年12月使用地西他滨(decitabine/Dacogen;DAC)方案和沙利度胺(thalidomide)+地塞米松(Dexamethasone,DXM)方案治疗骨髓增生异常综合征(MDS)中三种分型患者的疗效和不良反应。方法28例MDS患者,随机分二组,每组各14例,28 d为1周期,共4个疗程,完成方案后,进行观察结果比较。结果地西他滨方案和沙利度胺方案总有效率分别为92.85%、57.14%(P<0.01),部分及以上缓解率分别为64.28%、14.28%(P<0.01),其有效率、部分及以上缓解率明显高于沙利度胺方案(P<0.01)。在不良反应中地西他滨主要为骨髓抑制和诱发感染,而沙利度胺相对较轻,两组方案在骨髓抑制率和诱发感染率差异有统计学意义(P<0.05),其余不良反应两两比较无统计学意义(P>0.05)。结论与沙利度胺方案相比,地西他滨方案缓解率高、起效快、因其不良反应主要为骨髓抑制和诱发感染,应加强对症支持治疗。

Objective To evaluate the therapeutic effects and adverse reactions of Decitabine(Dacogen;DAC)and Thalidomide+Dexamethasone(DXM)in patients with Myelodysplastic Syndrome(MDS)admitted into the First People’s Hospital of Yunnan Province from 2017 to 2018.Methods Twenty-eight patients with MDS were randomly divided into two groups according to the drug regimen,14 patients in each group.Within a period of28 days,a total of 4 courses of treatment,observation and comparison between the two groups were made.Results Efficiency of Decitabine and Thalidomide was 92.85%and 57.14%,respectively(P<0.01).Partial and above remission rate of Decitabine was significantly higher than that of Thalidomide(64.28%and 14.28%,P<0.01).The adverse reactions of Decitabine were mainly bone marrow suppression and induced infection and were more severe than those of Thalidomide(P<0.05).There was no significant difference in other adverse reactions(P>0.05).Conclusions Decitabine has quicker effect and higher remission rates,but its adverse reactions are mainly bone marrow suppression and induced infection.Therefore,the treatment should be focused and supported.