地西他滨联合半量CAG方案治疗老年急性髓系白血病的疗效观察

Efficacy of decitabine combined with half amount CAG chemotherapy regimen in treating elderly acute myeloid leukemia

目的观察比较地西他滨联合半量阿糖胞苷、阿克拉霉素、粒细胞集落刺激因子(CAG)方案治疗老年急性髓系白血病(AML)与单用CAG方案化疗的有效性和安全性。方法选取2010年07月-2018年2月东莞市人民医院血液内科收治的老年AML患者56例,按照随机数字法分为观察组30例和对照组26例,观察组采用地西他滨联合半量CAG方案:地西他滨20 mg/m2,静脉用药d1-5;阿克拉霉素20 mg,静脉用药d1-4;阿糖胞苷10~15 mg/m2,皮下用药d1-7;粒细胞集落刺激因子(G-CSF)250μg,皮下用药d1-7;对照组单独行CAG方案:阿克拉霉素20 mg,静脉用药d1-4;阿糖胞苷10~15 mg/m2,皮下用药d1-14;G-CSF 250μg,皮下用药d1-14;当白细胞>20×109/L时,暂停应用G-CSF,待白细胞回落后再次应用,根据血常规调整。治疗2个疗程后,比较两组的临床疗效及不良反应发生情况。结果观察组患者的完全缓解(CR)率和总有效率分别为53.3%和73.3%,高于对照组的23.1%和38.5%,差异有统计学意义(P<0.05)。观察组化疗期间的不良反应发生情况与对照组比较,肺部感染(66.7%vs. 23.1%)、发热(46.7%vs. 11.5%)的发生率均明显增加,而血小板减少(13.3%vs. 38.5%)的发生率明显降低,差异均有统计学意义(P<0.05);其他不良反应差异无统计学意义,且不良反应在经过对症处理后均得到有效缓解。结论地西他滨联合半量CAG方案治疗老年AML疗效较好,但同时肺部感染、发热等药物不良反应增加,不良反应在经过对症处理后均得到有效缓解,而血小板减少降低,大部分病人可耐受,值得临床推广应用。

Objective To compare the efficacy and safety of decitabine combined with half amount cytarabine,aclacinomycin,granulocyte colony-stimulating factor(CAG)regimen and CAG alone in the treatment of elderly patients with acute myeloid leukemia(AML).Methods Fifty-six elderly patients with AML were enrolled.Thirty patients were treated with decitabine plus half amount CAG regimen as the observation group,and the remaining 26 patients treated with CAG alone were used as the control group.The observation group was treated with decitabine plus half amount CAG regimen:decitabine 20 mg/m2,intravenous d1-5;aclarithromycin 20 mg,intravenous d1-4;cytarabine 10~15 mg/m2,subcutaneous medication d1-7;granulocyte colony-stimulating factor(G-CSF)250μg,subcutaneous drug d1-7;control group alone CAG protocol:aclarithromycin 20 mg,intravenous d1-4;cytarabine 10~15 mg/m2,subcutaneous dosage d1-14;G-CSF 250μg,subcutaneous drug d1-14;when white blood cells>20×109/L,suspend the application of G-CSF,wait until the leukocytes fall back and apply again,according to blood routine adjustment.After 2 courses of treatment,the clinical efficacy and adverse reactions of the two groups were compared.Results The complete response(CR)rate and total effective rate of the observation group were 53.3%and 73.3%,respectively,which were significantly higher than those of the control group(23.1%and 38.5%,respectively)(P<0.05).The incidence of adverse reactions during the observation group was significantly higher than that of the control group.The incidence of pulmonary infection(66.7%vs.23.1%)and fever(46.7%vs.11.5%)was significantly increased,while thrombocytopenia(13.3%vs.38.5%)was significantly lower,and the differences were statistically significant(P<0.05,respectively).The difference of other adverse reactions was not statistically significant,and the adverse reactions were all effectively relieved after symptomatic treatment.Conclusions Decitabine combined with half amount CAG regimen was effective in the treatment of elderly AML,but at the same time,adverse drug reactions such as pulmonary infection and fever were increased,but thrombocytopenia was reduced,and most patients could tolerate them.It is worthy of popularization in future clinical practice.