摘要
目的比较地西他滨（DAC）联合半量CAG方案（D—CAG）与CAG方案治疗骨髓增生异常综合征伴原始细胞增多（MDS—EB）和急性髓系白血病伴骨髓增生异常相关改变（AML-MRC）的临床疗效及安全性。方法回顾性分析2011年5月至2017年3月42例初治MDS—EB和AML-MRC患者临床资料，21例接受D—CAG治疗，21例接受CAG方案治疗，诱导缓解后患者继续巩固化疗或进行allo-HSCT。比较两组患者的CR率、总有效率（ORR）、总生存（OS）率、无病生存（DFS）率和不良反应发生率。结果42例MDS-EB和AML—MRC患者中，男27例，女15例，中位年龄52．5（18—65）岁；MDS-EB21例，AML-MRC21例。D-CAG组和CAG组年龄、性别、疾病类型、基因突变类型和染色体核型差异均无统计学意义。D．CAG组2个疗程CR率为81．0％（17／21），高于CAG组的52．4％（11／21）（Z=3．857，P=0．050）。D—CAG组与CAG组2个疗程后ORR分别为85．7％（18／21）与76．2％（15／21），差异无统计学意义（X2=1．273，P=0．259）。D-CAG组和CAG组的中位随访时间分别为13（6～32）个月和15（2～36）个月，D．CAG组10例患者接受了allo-HSCT，CAG组7例患者接受了allo．HSCT。D—CAG组非移植患者的中位LFS时间为18．0（95％CI6．6～29．4）个月，CAG组非移植患者的中位LFS时间为11.0（95%CI 0～23．9）个月，两组1年累积LFS率分别为（63．6±14．5）％和（50．0±13．4）％，差异无统计学意义（X2=0．049，P=0．824）。D-CAG组11例非移植患者中2例死亡，CAG组非移植的14例患者中7例死亡，D—CAG组与CAG组非移植患者的1年累积OS率为（90．9±8．7）％对（61．5±13．5）％，D—CAG组高于CAG组，但差异无统计学意义（X2=1．840，P=0．175）。D—CAG组主要的不良反应为骨髓抑制所致的感染，化疗后肺部感染发生率为42．9％，与CAG组（38．1％）差异无统计学意义（P=0．753）。结论DAC联合半
Objective To evaluate the clinical efficacy and safety of decitabine in combination with lower-dose CAG regimen （G-CSF, cytarabine and aclarubicin; D-CAG regimen） in the treatment of myelodysplastic syndromes with excess blasts （MDS-EB） and acute myeloid leukemia with myelodysplasia- related changes （AML-MRC）, compared to standard CAG regimen. Methods A total of 42 patients with newly diagnosed MDS-EB and AML-MRC from May 2011 to March 2017 were included in the retrospective study. 21 cases were initially treated with G-CSF for priming, in combination with cytarabine of 10 mg/m2 ql2h for 14 days and aclarubicin of 20 mg/d for 4 days （CAG regimen） and the other 21 cases were initially treated with decitabine of 20 mg/m2 for 5 days and lower-dose CAG regimen （cytarabine of 10 mg/m2 ql2h for 7 days, aclarubicin of 10 mg/d for 4 days, and G-CSF for priming （D-CAG regimen）.After two cycles of induction chemotherapy, the patients who obtained complete remission（CR） received consolidation chemotherapy or hematopoietic stem cell transplantation （HSCT）. Results Among a total of 42 patients, the median age was 52.5 years （18-65 years） and 64.3% of them were male. Baseline characteristics of patients between D-CAG group and CAG group showed no significant differences. The CR for patients in D-CAG group was 81.0% （17/21）, compared to 52.4% （11/21） in CAG group after 2 cycles of therapy Of = 3.857, P = 0.050）. The overall response rate （ORR） for patients in D-CAG group and CAG group was 85.7% （18/21） and 76.2% （15/21） respectively, without significant difference Of = 1.273, P= 0.259）. By December 2017, the median follow-up of D-CAG group and CAG group was 13（6-32） months and 15（2-36） months respectively. Finally, I0 patients in D-CAG group and 7 patients in CAG group received HSCT respectively. Except patients receiving HSCT, the median leukemia-free survival （LFS） time for patients in D-CAG group and CAG group was 18.0 （95%CI 6.6-29.4） months and 11.0
作者
刘静
贾晋松
宫立众
卢晟晔
主鸿鹄
黄晓军
江浩
Liu Jing;Jia Jinsong;Gong Lizong;Lu Shengye;Zhu Honghu;Huang Xiaojun;Jiang Hao(Institute of Hematology,Peking University People＇s Hospital,Beijing 100044,China)
出处
《中华血液学杂志》
CAS
CSCD
北大核心
2018年第9期734-738,共5页
Chinese Journal of Hematology
基金
首都临床特色应用研究基金（Z181100001718126）
