摘要
本研究探讨G-CSF联合高三尖杉酯碱(homoharringtonine)和小剂量阿糖胞苷(cytarabine,Ara-C)的GHA预激化疗方案治疗难治性急性髓系白血病(AML)和骨髓增生异常综合征(MDS)的临床疗效和不良反应,寻求高效低毒的新型化疗方案,探索其与共刺激分子B7.1的关系。应用GHA标准预激化疗方案G-CSF[200μg/(m2·d)皮下注射,第1-14天];高三尖杉酯碱[1mg/(m2·d)静脉点滴,第1-14天];阿糖胞苷[10mg/m2,皮下注射,每12小时1次,第1-14天]治疗79例难治性急性髓系白血病和21例骨髓增生异常综合征,与传统MA方案化疗组比较,观察临床疗效和不良反应、治疗相关死亡率并随访。应用免疫荧光法检测各组肿瘤细胞上共刺激分子B7.1的表达并与临床疗效比较。结果表明:GHA预激化疗治疗后难治性AML缓解率60.7%(完全缓解率43%,部分缓解率17.7%),治疗MDS有效率52.4%。粒细胞缺乏发生率25%,平均持续时间3.5天。重症感染发生率3%,无严重出血、消化道反应,心、肝、肾功能损害轻微,患者均痊愈。治疗相关死亡率为零。AML-M2组、AML-M5组完全缓解率较高(60.9%,61.9%),最长持续缓解期已4年。各组肿瘤细胞上共刺激分子B7.1表达阳性率差异较大(0%-66.7%),正常对照组为0,AML-M2组和AML-M5组明显高于其它AML组和正常对照组,且表达率与预激化疗疗效呈正相关。结论:GHA预激化疗方案治疗难治性急性髓系白血病和骨髓增生异常综合征疗效肯定,不良反应较轻,无严重毒副作用和治疗相关死亡率,无病生存期长,是高效低毒的新型化疗方案。肿瘤细胞上共刺激分子B7.1表达可能与预激化疗疗效有关,其机理尚需进一步研究。
This study was purposed to explore the clinical efficiency and side effects of GIlA （G-CSF, homoharringtonine and low-dose cytarabine） priming chemotherapy for patients with refractory acute myeloid leukemia （AML） and myelodysplastic syndrome（ MDS）, and its relationship with B7.1 expression. 79 cases of refractory AML and 21 cases of MDS were treated with GIlA standard priming chemotherapy. Clinical efficiency, side effects, and therapy-relevant mortality were observed in comparison with MA therapy. Expression of costimulatory molecule B7. 1 was detected by immunofluoressence and its relationship with clinical efficiency was explored. The results showed that the remission rate in AML was 60.7% （complete remission rate was 43% and partial remission rate was 17.7% ）, and that was 52.4% in MDS. The incidence of granulocyte deficiency was 25% during 3.5 days. The severe infection rate was 3%, without severe bleeding, with mild digest effect, and slight damage of function in heart, liver, and kidney. The therapy-related mortality was zero. The higher CR rate was in AML-M2 and AML-M5 （60.9% ,61.9% ）, and the longest remission period was 4 years; expression rate of costimulatory molecule B7.1 displayed large variance （0% - 66.7% ） and had positive correlation with efficiency of priming chemotherapy. The rate of B7.1 expression was higher in AML-M2 and AML-M5 and lower in other AML groups and normal control. It is concluded that GHA priming chemotherapy can be used to treat refractory AML and MDS, without severe side effects, toxicity and therapy-related mortality. It is a new chemotherapy protocol with better effect and low toxicity. Efficiency of GHA priming chemotherapy may be correlated with B7.1 expression. Its mechanism is worthy to be further explored.
出处
《中国实验血液学杂志》
CAS
CSCD
2008年第5期1002-1005,共4页
Journal of Experimental Hematology
