地西他滨联合CAG方案治疗骨髓增生异常综合征-RAEB及难治性急性髓系白血病的临床观察

Clinical Efficacy of Decitabine Combined with CAG Regimen for Myelodysplastic Syndrome-RAEB and Refractory Acute Myeloid Leukemia

目的:观察地西他滨联合CAG方案治疗骨髓增生异常综合征-RAEB(MDS-RAEB)及难治性急性髓系白血病(AML)的临床疗效和不良反应。方法:回顾性分析2011年7月至2014年7月解放军总医院第一附属医院收治的21例MDS-RAEB及难治性AML患者临床疗效,给予患者地西他滨+CAG方案治疗:地西他滨20 mg/(m2·d),d 1-5;阿柔比星10 mg/d,d 6-13;阿糖胞苷20 mg/d,d 6-19;重组粒细胞集落刺激因子(G-CSF)300μg/d,d 6-19)。结果:1个疗程后,21例患者中完全缓解8例(42.1%),部分缓解8例(42.1%),血液学改善2例,未缓解1例,死亡2例;1年总生存(OS)率为67.5%。12例年龄≥60岁患者中完全缓解6例(60%,6/10),1年OS率为62.5%。13例高危核型患者中完全缓解6例(54.5%,6/11);1年OS率为61.5%。治疗不良反应主要为骨髓抑制,非血液学不良反应主要为肝功能损害和胃肠道反应。结论:地西他滨联合CAG方案治疗MDS-RAEB及难治性AML安全有效,可延长难治恶性血液病患者生命。

Objective:To investigate the therapeutic efficacy and side effects of treating patients with myelodysplastic syndrome-RAEB(MDS-RAEB) and with refractory acute myeloid leukemia(AML) by using decitabine combined with CAG regimen.Methods:Clinical data of 21 patients with MDS-RAEB or refractory AML from July 2011 to July 2014 were analyzed retrospectively.Among 21 patients there were 4 cases of MDObjective:To investigate the therapeutic efficacy and side effects of treating patients with myelodysplastic syndrome-RAEB(MDS-RAEB) and with refractory acute myeloid leukemia(AML) by using decitabine combined with CAG regimen.Methods:Clinical data of 21 patients with MDS-RAEB or refractory AML from July 2011 to July 2014 were analyzed retrospectively.Among 21 patients there were 4 cases of MDS-RAEB and 17 cases of refractory AML;12 cases were beyond 60 years old;13 cases had high-risk karyotypes.All the patients received decitabine combined with CAG regimen consisting of decitabine 20 mg/(m2 ·d),d 1-5;aclarubicin 10 mg/d,d6-13;cytarabine 20 mg/d,d 6-19;G-CSF 300 μg/d,d 6-19.Results:After 1 cycle of treatment with DCAG regimen,the outcome of 21 patients showed that 8 cases achieved complete remission(42.1%),8 cases achieved partial remission(42.1%),2 cases achieved hematologic improvement,1 cases achieved non-remission and 2cases died;and the 1 year overall survival rate was 67.5%.The outcome of 12 patients beyond 60 years old showed that6 cases achieved complete renission(60%,6/10),and the 1 year overall survival rate was 62.5%.The outcome of 13 patients with high-risk karytype showed that 6 cases achieved complete renission(54.5%,6/11),and the 1 year overall survival rate was 61.5%.The main adverse event was myelosuppression,and non-hematological toxicity included liver dysfunction and gastrointestinal tract reaction.Conclusion:Decitabine combined with CAG regimen is effective and safe for treatment of MDS-RAEB and refractory AML patients,which can prolong lives of patiens with refractory hematological diseases.S-RAEB and 17 cases of refractory AML;12 cases were beyond 60 years old;13 cases had high-risk karyotypes.All the patients received decitabine combined with CAG regimen consisting of decitabine 20 mg/(m2 ·d),d 1-5;aclarubicin 10 mg/d,d6-13;cytarabine 20 mg/d,d 6-19;G-CSF 300 μg/d,d 6-19.Results:After 1 cycle of treatment with DCAG regimen,the outcome of 21 patients showed that 8 cases achieved complete remission(42.1%),8 cases achieved partial remission(42.1%),2 cases achieved hematologic improvement,1 cases achieved non-remission and 2cases died;and the 1 year overall survival rate was 67.5%.The outcome of 12 patients beyond 60 years old showed that6 cases achieved complete renission(60%,6/10),and the 1 year overall survival rate was 62.5%.The outcome of 13 patients with high-risk karytype showed that 6 cases achieved complete renission(54.5%,6/11),and the 1 year overall survival rate was 61.5%.The main adverse event was myelosuppression,and non-hematological toxicity included liver dysfunction and gastrointestinal tract reaction.Conclusion:Decitabine combined with CAG regimen is effective and safe for treatment of MDS-RAEB and refractory AML patients,which can prolong lives of patiens with refractory hematological diseases.