地西他滨方案治疗骨髓增生异常综合征及急性髓系白血病疗效分析
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摘要
目的探讨地西他滨方案治疗骨髓增生异常综合征(MDS)和急性髓系白血病(AML)的疗效及安全性。方法回顾性分析医院2016年1月至2017年6月收治的地西他滨方案化疗的84例MDS/AML患者的临床资料,其中MDS 21例,AML 63例。随机将MDS患者分为A组(10例,地西他滨)和B组(11例,联合化疗),将AML患者分为C组(20例,地西他滨)和D组(43例,联合化疗)。结果 84例MDS/AML患者中,完全缓解59例(70.23%),部分缓解11例(13.10%),总有效率为83.33%(70/84);Ⅳ级血液学不良反应发生率为78.57%(66/84),感染发生率为52.38%(44/84),因不良反应致死发生率为4.76%(4/84)。结论地西他滨单药或联合方案治疗MDS和AML有一定疗效,可延缓疾病进展,其不良反应主要为骨髓抑制和感染,需输血及抗感染等支持治疗,部分患者经积极对症支持治疗可以耐受。
Objective To investigate the clinical effect and safety of decitabine regimen in the treatment of myelodysplastic syndrome(MDS)and acute myeloid leukemia(AML).Methods The clinical data of 84 patients with MDS or AML treated by chemotherapy regimens containing decitabine in our hospital from January 2016 to June 2017 were analyzed retrospectively.Among 84 patients,there were 21 cases of MDS and 63 cases of AML.The patients with MDS were randomly divided into group A(10 cases,dicetabine) and group B(11 cases,combined chemotherapy).The patients with AML were randomly divided into group C(20 cases, dicetabine) and group D(43 cases,combined chemotherapy).Results Among 84 patients with MDS or AML, complete remission(CR) was 59 cases(70.23%), partial remission rate(PR) was 11 cases(13.10%),the total effective rate was 83.33%(70/84).The incidence rate of grade Ⅳ hematological adverse reactions was 78.57%(66/84), and the incidence rate of infection was 52.38%(44/84), the mortality rate due to adverse reactions was 4.76%(4/84).Conclusion Dicetabine alone or combined regimens can effectively treat MDS and AML to some extent and can delay the progress of the disease.The main adverse reactions are bone marrow suppression and infection,the blood transfusion and anti-infection supportive treatment were required,some patients with positive support therapy can be tolerated.
Objective To investigate the clinical effect and safety of decitabine regimen in the treatment of myelodysplastic syndrome(MDS)and acute myeloid leukemia(AML).Methods The clinical data of 84 patients with MDS or AML treated by chemotherapy regimens containing decitabine in our hospital from January 2016 to June 2017 were analyzed retrospectively.Among 84 patients,there were 21 cases of MDS and 63 cases of AML.The patients with MDS were randomly divided into group A(10 cases,dicetabine) and group B(11 cases,combined chemotherapy).The patients with AML were randomly divided into group C(20 cases, dicetabine) and group D(43 cases,combined chemotherapy).Results Among 84 patients with MDS or AML, complete remission(CR) was 59 cases(70.23%), partial remission rate(PR) was 11 cases(13.10%),the total effective rate was 83.33%(70/84).The incidence rate of grade Ⅳ hematological adverse reactions was 78.57%(66/84), and the incidence rate of infection was 52.38%(44/84), the mortality rate due to adverse reactions was 4.76%(4/84).Conclusion Dicetabine alone or combined regimens can effectively treat MDS and AML to some extent and can delay the progress of the disease.The main adverse reactions are bone marrow suppression and infection,the blood transfusion and anti-infection supportive treatment were required,some patients with positive support therapy can be tolerated.
引文
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[15]LüBBERT M,RüTER BH,CLAUS R,et al.A multicenter phaseⅡtrial of decitabine as first-line treatment for older patients with acute myeloid leukemia judged unfit for induction chemotherapy[J].Haematologica,2012,97(3):393-401.
[16]邵秀茹,梁红,关晓军,等.地西他滨治疗中、高危骨髓增生异常综合征患者的临床研究[J].中华血液学杂志,2011,32(11):789-791.
[2]AD?S L,ITZYKSON R.Myelodysplastic syndromes[J].Lancet(London,England),2014,383(9936):2239-2252.
[3]D?HNER H,WEISDORF DJ,BLOOMFIELD CD.Acute Myeloid Leukemia[J].The New England Journal of Medicine,2015,373(12):1136-1152.
[4]CASHEN AF,SCHILLER GJ,O'DONNELL MR,et al.Multicenter,phaseⅡstudy of decitabine for the first-line treatment of older patients with acute myeloid leukemia[J].Journal of Clinical Oncology,2010,28(4):556-561.
[5]JING Y,SHEN X,MEI Q,et al.Spotlight on decitabine for myelodysplastic syndromes in Chinese patients[J].Oncotargets&Therapy,2015(8):2783-2790.
[6]中华医学会血液学分会.骨髓增生异常综合征诊断与治疗中国专家共识(2014年版)[J].中华血液学杂志,2014,35(11):1042-1048.
[7]中华医学会血液学分会白血病淋巴瘤学组.成人急性髓系白血病(非急性早幼粒细胞白血病)中国诊疗指南(2017年版)[J].中华血液学杂志,2017,38(3):177-182.
[8]张之南,沈悌.血液病诊断与疗效标准[M].第3版.北京:科学出版社,2008:99-163.
[9]SABA HI.Decitabine in the treatment of myelodysplastic syndromes[J].Therapeutics&Clinical Risk Management,2007,3(5):807.
[10]WU D,DU X,JIN J,et al.Decitabine for Treatment of Myelodysplastic Syndromes in Chinese Patients:An Open-Label,Phase-3b Study[J].Advances in Therapy,2015,32(11):1140.
[11]LüBBERT M,SUCIU S,BAILA L,et al.Low-dose decitabine versus best supportive care in elderly patients with intermediate-or high-risk myelodysplastic syndrome(MDS)ineligible for intensive chemotherapy:final results of the randomized phaseⅢstudy of the European Organisation for Resea[J].Journal of Clinical Oncology Official Journal of the American Society of Clinical Oncology,2011,29(15):1987.
[12]GARCIAMANERO G,SHAN J,FADERL S,et al.A prognostic score for patients with lower risk myelodysplastic syndrome[J].Leukemia,2008,22(3):538-543.
[13]SCANDURA JM,ROBOZ GJ,MOH M,et al.Phase 1 study of epigenetic priming with decitabine prior to standard induction chemotherapy for patients with AML[J].Blood,2011,118(6):1472-1480.
[14]GHANEM H,CORNELISON AM,GARCIAMANERO G,et al.Decitabine Can Be Safely Reduced after Achievement of Best Objective Response in Patients with Myelodysplastic Syndrome[J].Clinical Lymphoma Myeloma&Leukemia,2013,13(Suppl 2):S289.
[15]LüBBERT M,RüTER BH,CLAUS R,et al.A multicenter phaseⅡtrial of decitabine as first-line treatment for older patients with acute myeloid leukemia judged unfit for induction chemotherapy[J].Haematologica,2012,97(3):393-401.
[16]邵秀茹,梁红,关晓军,等.地西他滨治疗中、高危骨髓增生异常综合征患者的临床研究[J].中华血液学杂志,2011,32(11):789-791.