地西他滨联合HAA方案治疗儿童白血病疗效分析

Efficacy of decitabine combined with HAA regimen in treatment of children with leukemia

目的:评价地西他滨(decitabine,DAC)联合高三尖杉酯碱(HHT)、阿糖胞苷(Ara-C)、阿克拉霉素化疗(ACR)(HAA方案)治疗儿童复发/难治急性髓系白血病(R/R AML)的有效性及安全性。方法:采用DAC结合HAA方案治疗46例1~14岁儿童急性髓系白血病(复发/难治性),其中30例患儿被诊断为复发性AML,16例患儿被诊断为难治性AML。对这一方案的安全性、有效性等予以回顾性分析。结果:共有32例患儿(69.5%)在第一个疗程的诱导治疗后获得完全缓解(CR),5例患儿(10.8%)获得部分缓解(PR),其中总有效率为80.3%。性别、年龄、疾病状态对缓解率没有显著影响。共有28例患儿(60.8%)出现4级骨髓抑制,32例患儿(69.5%)出现不同程度感染,其中肺炎20例(43.5%),5例患儿出现化疗期间可逆性肝功能异常,未出现心功能及肾功能损伤患者。结论:DAC联合HAA方案治疗难治复发性儿童AML缓解率高,安全性好,可考虑作为造血干细胞移植前桥接方案。

Objective:To study the efficacy and safety of dexamethasone(DAC)combined with homoharringtonine(HHT),cytarabine(Ara-C),and clarithromycin chemotherapy(ACR)(HAA regimen)in treatment of refractory/relapsed acute myeloid leukemia(R/R AML)in children.Methods:A combination of HAA and DAC regimen was used to treat 46 children aged 1-14 with R/R AML.Among them,30 children were diagnosed to suffer from relapsed AML and 16 children were diagnosed to suffer from refractory AML.Retrospective analysis of the effectiveness and safety of the plan was conducted.Results:A total of 32 children(69.5%)achieved complete remission(CR)after the first course of induction therapy,and 5 children(10.8%)achieved partial remission(PR),with a total effective rate of 80.3%.Gender,age,and disease status had no significant impact on the remission rate.A total of 28 children(60.8%)experienced grade 4 bone marrow suppression,32 children(69.5%)experienced varying degrees of infection,including 20 cases of pneumonia(43.5%),and 5 children experienced reversible liver function abnormalities during chemotherapy.There were no patients with heart or kidney function damage.Conclusion:The combination of DAC and HAA regimen has a high remission rate and good safety in the treatment of refractory and recurrent AML in children,and can be considered as a pre hematopoietic stem cell transplantation bridging regimen.