摘要
目的:评估地西他滨联合低剂量CEG方案(DCEG)与地西他滨联合低剂量CAG方案(DCAG)治疗老年MDS和MDS转化的急性髓系白血病(AML)患者的疗效。方法:在7个医疗中心开展前瞻性研究,选取2016年10月至2019年1月年龄≥60岁的MDS和MDS转化的AML患者共45例,中位年龄68.5岁。按照IPSS-R评分,患者危险度分层均为高危或者极高危。将地西他滨联合CEG方案与地西他滨联合CAG方案的治疗结果进行比较。结果:DCEG与DCAG组比较结果显示,总有效率(ORR,86.4%vs 47.8%)、总生存时间(OS,10 vs 6个月)和无进展生存时间(PFS,9 vs 3个月),DCEG均显示有优势(P<0.05)。在MDS患者中,DCEG组患者50%取得了PR或PR以上的疗效,中位OS时间长达31个月。多因素分析显示,经诱导治疗达PR或以上以及应用DCEG方案患者具有更长的生存时间。2组的骨髓抑制和感染的发生率、治疗相关死亡率相似。结论:与DCAG方案相比,DCEG方案可以改善高危MDS和MDS转AML患者的生存。这一结论需要更大规模的前瞻性随机临床研究来验证。
Objective:To evaluate the efficacy of decitabine combined with low-dose CEG regimen(DCEG)and decitabine combined with low-dose CAG regimen(DCAG)in the treatment of elderly patients with MDS and MDStransformed acute myeloid leukemia(AML).Methods:A prospective study was conducted in 7 medical centers,45 patients with MDS(≥60 years old)and MDS-transformed AML from October 2016 to January 2019 were enrolled,with the median age of 68.5 years old.The risk stratification of patients was poor or very poor,according to IPSS-R score.The treament results of decitabine combined with CEG and decitabine combined with CAG were compared.Results:The comparison of the two regiem showed that the DCEG regimen had advantages on total effective rate(ORR,86.4%vs 47.8%,respectively),overall survival time(OS)(10.0 months vs 6.0 months,respectively)and progression-free survival time(PFS)(9.0 months vs 3.0 months,respectively).About 50%of MDS patients treated by DCEG regimen achieved PR or CR,with a median OS of 31 months.Multivariate analysis showed that patients with PR or CR after induction therapy and DCEG regimen had longer survival time(31months).The incidence of bone marrow suppression,infection and treatment-related mortality rate were similar between the two groups.Conclusion:Decitabine combined with CEG regimen could improve the survival of patients with high-risk MDS and MDS-transformed AML.The conclusion of the reaserch needs to be validated by a larger prospective randomized clinical trial.
作者
吴敏
马洁娴
谢彦晖
叶琇锦
何合胜
花京剩
杨如玉
王小华
王小钦
李菲
WU Min;MA Jie-Xian;XIE Yan-Hui;YE Xiu-Jin;HE He-Sheng;HUA Jing-Sheng;YANG Ru-Yu;WANG Xiao-Hua;WANG Xiao-Qin;LI Fei(Department of Hematology,Huadong Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Hematology,The First Affiliated Hospital,College of Medicine,Zhejiang University,Hangzhou 310003,Zhejiang Province,China;Department of Hematology,The First Affiliated Hospital of Anhui Southern Anhui Medical College,Wuhu 241001,Anhui Province,China;Department of Hematology,Taizhou State Hospital,Taizhou 318000,Zhejiang Province,China;Department of Hematology,Nanyang Central Hospital of Henan Province,Nanyang 473009,Henan Province,China;Department of Hematology,Wuhu Second People′s Hospital of Anhui Province,Wuhu 241000,Anhui Province,China;Department of Hematology,Huashan Hospital Affiliated to Fudan University,Shanghai 200040,China;Department of Hematology,First Affiliated Hospital of Nanchang University,Nanchang 330006,Jiangxi Province,China)
出处
《中国实验血液学杂志》
CAS
CSCD
北大核心
2020年第6期1991-1997,共7页
Journal of Experimental Hematology
基金
上海市申康项目〔批准号16CR2023A〕
上海市科委〔批准16411971000〕。
