摘要
目的:分析多疗程地西他滨治疗骨髓增生异常综合征(MDS)及急性髓系白血病(AML)患者的临床疗效与安全性。方法:对接受地西他滨治疗的30例MDS患者及27例AML患者进行回顾性分析。结果:地西他滨单药治疗MDS患者中,随着疗程数增加,完全缓解(CR)/骨髓完全缓解(mCR)率增加,差异有统计学意义(P=0.047)。对可能影响疗效的临床特征分析发现,在MDS患者中,重度贫血对CR/mCR有影响(P=0.042);在AML患者中,预后分层对CR/mCR有影响(P=0.016)。地西他滨治疗MDS患者相关并发症分析中,单药方案1个疗程粒细胞减少中位时间为10(0~25)d,2个疗程为6(0~24)d,3个疗程为4(0~10)d;联合方案中,1个疗程粒细胞减少中位时间为11(0~30)d,2个疗程为8(0~30)d,3个疗程为4(0~11)d;肺部感染发生率为30.0%,治疗相关死亡1例(为移植后复发)。地西他滨单药及联合方案治疗AML患者,1个疗程粒细胞减少中位时间为21(0~37)d,2个疗程为13(0~37)d,3个疗程为13(0~18)d;肺部感染发生率为40.7%,治疗相关死亡2例。通过多因素COX比例风险模型分析发现,IPSS评分及铁过载是影响MDS患者总生存的预后因素(P=0.031、0.042),而预后危险分层是影响AML患者总生存的预后因素(P=0.013)。结论:地西他滨治疗MDS/AML疗效确切,单药治疗MDS患者中,随着疗程数增加,缓解率增加;地西他滨不良事件具有可控性,安全性好,大部分患者可以安全度过化疗后骨髓抑制期。
Objective：To observe the clinical efficacy and safety of multiple courses of decitabine treatment in patients of myelodyspiastic syndrome and acute myeloid leukemia （MDS/AML）. Method：We retrospectively analyzed the clinical data of 30 MDS patients and 27 AML patients. Result： In MDS patients treated with decitabine a-lone,CR/mCR rate was increased along with increased course of treatment, and there was a significant statistical difference （P = 0. 047）. In MDS patients, severe anemia had a significant relationship with the efficacy （P = 0. 042）,and in AML patients,prognostic was also notably related with the efficacy （P=0. 016）. We analyzes adverse events,such as duration of neutropenia and infection caused by decitabine, an found that in MDS patients treated with decitabine alone or combined with chemotherapy, the average times of neutropenia in three different courses were 10 d,6 d,4 dill d,8 d,4 d, respectively. In AML patients were 21 d,13 d and 13 d. In MDS/AML patients,the incidence of pulmonary infection were 30. 0% and 40. 7%. Treatment-related deaths were 1 case in MDS and 2 cases in AML. The result showed that IPSS and iron overload could affect the overall survival in MDS patients （P=0. 031,0. 042）. Prognostic risk stratification could affect the overall survival in AML patients （P= 0. 013） by multivariable COX regression analysis. Conclusion.. Treating MDS/AML with decitabine alone or in combination with chemotherapy can produce high efficacy,with well tolerated toxicity.
出处
《临床血液学杂志》
CAS
2017年第2期198-201,205,共5页
Journal of Clinical Hematology
基金
国家自然科学基金(No:81570138)
江苏省自然科学基金(No:BK20131168)
江苏省科教兴卫工程-临床医学中心(No:ZX201102)
江苏省血液病临床医学研究中心(江苏省科技厅生命健康专项-BL2012005)资助
