CLAG-M在挽救治疗复发难治性急性髓系白血病中的临床意义

Clinical significance of CLAG-M in treatment of relapsed refractory acute myeloid leukemia

目的评价CLAG-M方案在挽救治疗复发难治性急性髓系白血病(RR-AML)患者中的临床意义。方法回顾性分析2016年6月—2017年12月在河南大学人民医院血液科采用CLAG-M方案治疗的16例RR-AML患者的临床资料。结果16例患者中获得完全缓解(CR)11例(68.25%),部分缓解(PR)1例(6.25%),未缓解(NR)4例(25.00%),总有效率(ORR)=CR+PR(75.00%),16例患者的中位总生存期为21.5个月,中位疾病无进展生存期为14.5个月;CLAG-M化疗后微小残留病灶(MRD)<0.02%的患者生存情况明显优于MRD>0.02%的患者(P=0.000、P=0.004),化疗期间的粒缺期≥7天及危险度分组处于中、高危组被认为是治疗失败的不利因素(P=0.021、P=0.006)。CLAG-M方案的毒副反应主要表现为粒细胞缺乏及血小板减少导致的感染和出血。结论CLAG-M方案治疗复发难治性急性髓系白血病缓解率较高;耐受性好;化疗后达到深度骨髓缓解的患者可能获得较长的生存期。

Objective To evaluate the clinical significance of CLAG-M regimen in the treatment of recurrent and refractory acute myeloid leukemia(RR-AML).Methods From June 2016 to December 2017,totally 16 patients with RR-AML were treated with CLAG-M regimen in hematology department of our hospital.Results Among 16 patients,11 patients achieved complete remission(CR)(68.25%),11 patients achieved partial remission(PR)(6.25%),4 patients achieved non-remission(NR)(25.00%),Overall response rate(ORR)=CR+PR(75%).The median overall survival time of 16 patients was 21.5 months,and the median progression-free survival time was 14.5 months.The survival rate of patients with minimal residual lesions(MRD)<0.02%after CLAG-M chemotherapy was significantly better than that of patients with MRD>0.02%(P=0.000,P=0.004).The granulocytopenia time≥7 days during chemotherapy and the risk group in the middle or high risk group were considered as adverse factors for treatment failure(P=0.021,P=0.006).The toxic and side effects of CLAG-M regimen were mainly manifested as infection and bleeding caused by granulopenia and thrombocytopenia.Conclusion CLAG-M regimen has a high remission rate and good tolerance in the treatment of recurrent and refractory acute myeloid leukemia.Patients with deep bone marrow remission after chemotherapy may have a longer survival time.