超低剂量地西他滨联合GHA预激治疗复发难治性急性髓系白血病疗效研究

Efficacy of low-dose decitabine combined with GHA regimen for patients with recurrent and refractory acute myeloid leukemia

目的探讨超低剂量地西他滨联合高三尖杉酯碱(HHT)、阿糖胞苷(Ara-c)和粒细胞集落刺激因子(G-CSF)的GHA预激方案治疗复发难治性急性髓系白血病(AML)的临床疗效及其安全性。方法回顾性分析2018年1月—2023年8月在我院接受2个疗程超低剂量地西他滨联合GHA预激方案(具体为:地西他滨10 mg/d,静脉滴注,第1~5天;HHT 1 mg/d,静脉滴注,第1~14天;Ara-c 10 mg,q 12 h,皮下注射,第1~14天;G-CSF 300μg,皮下注射,第0~14天)治疗的28例复发难治性AML患者的临床资料,评价治疗效果及不良反应。结果2疗程后共有17例患者获得完全缓解(CR)(60.7%),6例获得部分缓解(PR)(21.4%),总有效率(ORR)82.1%。26例(92.9%)患者发生IV级骨髓抑制,中性粒细胞缺乏的比例为85.7%(24例),平均持续时间7 d(3~14 d);血小板<20×10^(9)/L的比例为89.3%(25例),平均持续时间8 d(5~17 d)。非血液系统不良反应轻微,无早期死亡发生。结论超低剂量地西他滨联合GHA预激方案治疗复发难治性AML缓解率高,耐受性好,可在临床推广应用。

Objective To observe the clinical efficacy and safety of the GHA priming regimen of ultra-low-dose decitabine combined with hypertriglyceridin(HHT),cytarabine(Ara-c),and granulocyte colony-stimulating factor(G-CSF)in the treatment of refractory and relapsed acute myeloid leukaemia(AML).Methods A retrospective analysis was performed from January 2018 to August 2023 in our hospital involving 28 patients with refractory and relapsed AML received 2 courses of ultra-low-dose decitabine combined with GHA priming regimen(specifically:decitabine 10 mg/d,intravenous drip,d1-5;HHT,1 mg/d intravenous drip,d1-14;Ara-c,10 mg,q12h,subcutaneous injection,d1-14;G-CSF,300μg,subcutaneous injection,d0-14),and the therapeutic effects and adverse reactions were evaluated.Results A total of 17 patients achieved complete remission(CR)(60.7%)and 6 achieved partial remission(PR)(21.4%)after 2 courses of treatment,with an overall effective rate(ORR)of 82.1%.Grade IV myelosuppression occurred in 26 patients(92.9%),with a neutrophil deficiency of 85.7%(24 patients),with a mean duration of 7 days(3-14 days);platelets<20×10^(9)/L were 89.3%(25 patients)with a mean duration of 8 days(5-17 days).The non-haematological adverse effects were mild and no early deaths occurred.Conclusion Ultra-low-dose decitabine combined with GHA priming regimen for the treatment of refractory and relapsed AML has a high remission rate and is well tolerated,which is worthy of promotion and application.