地西他滨辅助MAC方案治疗复发难治性急性髓系白血病的疗效观察
|
摘要
目的:探讨地西他滨辅助MAC方案(米托蒽醌、阿糖胞苷和环磷酰胺)治疗复发难治性急性髓系白血病的疗效。方法:选取2014年12月至2018年1月内蒙古医科大学附属医院收治的复发难治性急性髓系白血病患者162例,采用随机数字表法分为观察组和对照组,每组81例。对照组患者给予MAC方案治疗,观察组患者在对照组的基础上加用地西他滨治疗。比较两组患者的临床疗效、血液学指标[白细胞计数(WBC)、血红蛋白(HGB)和血小板计数(PLT)]水平、外周血S期细胞百分比(SPF)和胸腺嘧啶核苷激酶1(TK1)水平、不良反应发生情况及远期生存情况。结果:观察组患者的总有效率为75.31%(61/81),明显高于对照组的39.51%(32/81);治疗后,两组患者的WBC水平明显低于治疗前,HGB和PLT水平明显高于治疗前,且观察组患者上述指标水平明显优于对照组;治疗后,两组患者SPF、TK1水平明显低于治疗前,且观察组患者明显低于对照组;治疗期间,观察组患者PLT降低和心力衰竭的发生率明显低于对照组;观察组患者6个月、1年生存率明显高于对照组,上述差异均有统计学意义(P<0.05)。结论:地西他滨辅助MAC方案治疗复发难治性急性髓系白血病的疗效较好,可改善患者血液学指标水平,降低外周血SPF、TK1水平,提高远期生存率,安全有效,值得临床进一步研究。
OBJECTIVE:To probe into the efficacy of decitabine combined with MAC(mitoxantrone, cytarabine and cyclophosphamide)regimen in treatment of recurrent and refractory acute myelogenous leukemia. METHODS:162 patients with recurrent and refractory acute myelogenous leukemia admitted into Affiliated Hospital of Inner Mongolia Medical University from Dec. 2014 to Jan. 2018 were selected and divided into observation group and control group via random number table, with 81 cases in each group. The control group was treated with MAC regimen, while the observation group was given decitabine combined with MAC regimen. Differences in clinical efficacy, haematological indices [white blood cell count(WBC), hemoglobin(HGB)and blood platelet count(PLT)], S-cell phase fraction(SPF)and thymidine kinase 1(TK1)of peripheral blood, incidence of adverse drug reactions and long-term survival rate between two groups were compared. RESULTS:The total effective rate of observation group was 75.31%(61/81), which was significantly higher than that of the control group(39.51%, 32/81); after treatment, the WBC levels of both groups had been significantly decreased, the HGB and PLT levels of both groups were significantly higher than those of before treatment, the WBC, HGB and PLT levels of observation group were significantly better than those of the control group; after treatment, the SPF and TK1 levels of both group had been significantly decreased, and those of the observation group were significantly lower than the control group; during treatment, the incidences of PLT decreasing and heart failure were significantly lower than those of the control group; the 6-month and 1-year survival rates of observation group were significantly higher than those of the control group, with statistically significant differences(P<0.05). CONCLUSIONS:The efficacy of decitabine combined with MAC regimen in treatment of recurrent and refractory acute myelogenous leukemia is remarkable, which can improve haematological indices, decrease SPF and TK1 levels of peripheral blood, promote long-term survival rate, with safety and effectiveness, which is worthy of further study.
OBJECTIVE:To probe into the efficacy of decitabine combined with MAC(mitoxantrone, cytarabine and cyclophosphamide)regimen in treatment of recurrent and refractory acute myelogenous leukemia. METHODS:162 patients with recurrent and refractory acute myelogenous leukemia admitted into Affiliated Hospital of Inner Mongolia Medical University from Dec. 2014 to Jan. 2018 were selected and divided into observation group and control group via random number table, with 81 cases in each group. The control group was treated with MAC regimen, while the observation group was given decitabine combined with MAC regimen. Differences in clinical efficacy, haematological indices [white blood cell count(WBC), hemoglobin(HGB)and blood platelet count(PLT)], S-cell phase fraction(SPF)and thymidine kinase 1(TK1)of peripheral blood, incidence of adverse drug reactions and long-term survival rate between two groups were compared. RESULTS:The total effective rate of observation group was 75.31%(61/81), which was significantly higher than that of the control group(39.51%, 32/81); after treatment, the WBC levels of both groups had been significantly decreased, the HGB and PLT levels of both groups were significantly higher than those of before treatment, the WBC, HGB and PLT levels of observation group were significantly better than those of the control group; after treatment, the SPF and TK1 levels of both group had been significantly decreased, and those of the observation group were significantly lower than the control group; during treatment, the incidences of PLT decreasing and heart failure were significantly lower than those of the control group; the 6-month and 1-year survival rates of observation group were significantly higher than those of the control group, with statistically significant differences(P<0.05). CONCLUSIONS:The efficacy of decitabine combined with MAC regimen in treatment of recurrent and refractory acute myelogenous leukemia is remarkable, which can improve haematological indices, decrease SPF and TK1 levels of peripheral blood, promote long-term survival rate, with safety and effectiveness, which is worthy of further study.
引文
[1] Levis M.Midostaurin approved for FLT3-mutated AML[J].Blood,2017,129(26):3403-3406.
[2] Shafer D,Grant S.Update on rational targeted therapy in AML[J].Blood Rev,2016,30(4):275-283.
[3] 张巧,刘林,廖明燕,等.配型相合同胞供者与单倍体相合造血干细胞移植治疗恶性血液病的单中心临床研究[J].国际输血及血液学杂志,2016,39(3):191-199.
[4] Estey E.Acute myeloid leukemia:2016 Update on risk-stratification and management[J].Am J Hematol,2016,91(8):824-846.
[5] Tripathi S,Pradeep TP,Barthwal R.Molecular Recognition of Parallel DNA Quadruplex d(TTAGGGT)4 by Mitoxantrone:Binding with 1:2 Stoichiometry Leading to Thermal Stabilization and Telomerase Inhibition[J].Chembiochem,2016,17(7):554-560.
[6] 张旗,慕俐君,李伟平,等.大剂量阿糖胞苷治疗急性髓细胞白血病疗效及不良反应观察[J].医学与哲学,2016,37(2):44-46.
[7] 钟金凤,方热军.环磷酰胺免疫抑制机制及在动物模型上的应用[J].中国免疫学杂志,2016,32(10):1541-1546.
[8] Vasu S,He S,Cheney C,et al.Decitabine enhances anti-CD33 monoclonal antibody BI 836858-mediated natural killer ADCC against AML blasts[J].Blood,2016,127(23):2879-2889.
[9] 丁卓玲,邓明凤,唐元艳,等.地西他滨联合减量米托蒽醌+阿糖胞苷方案治疗复发难治性急性髓系白血病的临床疗效及安全性分析[J].中国全科医学,2016,19(6):702-705.
[10] 王贺孔,任党利,靳颖,等.急性髓系白血病患者外周血TK1和SPF的分析[J].检验医学,2017,32(10):890-893.
[11] 高雯慧,李红敏,于靖宜,等.不同挽救治疗方案对初始诱导失败和复发的急性髓系白血病患者的疗效比较[J].中国实验血液学杂志,2017,25(2):340-345.
[12] Seelan RS,Mukhopadhyay P,Pisano MM,et al.Effects of 5-Aza-2′-deoxycytidine (decitabine) on gene expression[J].Drug Metab Rev,2018,50(2):193-207.
[13] Abedin S,Platanias LC.PD1 and PDL1 upregulation and survival after decitabine treatment in lower risk MDS[J].Leuk Lymphoma,2017,58(4):764-765.
[14] 陈思思,赵彦平,吴文忠,等.地西他滨联合三氧化二砷对急性髓系白血病MV4-11细胞增殖和凋亡的影响[J].中国实验血液学杂志,2016,24(5):1343-1347.
[2] Shafer D,Grant S.Update on rational targeted therapy in AML[J].Blood Rev,2016,30(4):275-283.
[3] 张巧,刘林,廖明燕,等.配型相合同胞供者与单倍体相合造血干细胞移植治疗恶性血液病的单中心临床研究[J].国际输血及血液学杂志,2016,39(3):191-199.
[4] Estey E.Acute myeloid leukemia:2016 Update on risk-stratification and management[J].Am J Hematol,2016,91(8):824-846.
[5] Tripathi S,Pradeep TP,Barthwal R.Molecular Recognition of Parallel DNA Quadruplex d(TTAGGGT)4 by Mitoxantrone:Binding with 1:2 Stoichiometry Leading to Thermal Stabilization and Telomerase Inhibition[J].Chembiochem,2016,17(7):554-560.
[6] 张旗,慕俐君,李伟平,等.大剂量阿糖胞苷治疗急性髓细胞白血病疗效及不良反应观察[J].医学与哲学,2016,37(2):44-46.
[7] 钟金凤,方热军.环磷酰胺免疫抑制机制及在动物模型上的应用[J].中国免疫学杂志,2016,32(10):1541-1546.
[8] Vasu S,He S,Cheney C,et al.Decitabine enhances anti-CD33 monoclonal antibody BI 836858-mediated natural killer ADCC against AML blasts[J].Blood,2016,127(23):2879-2889.
[9] 丁卓玲,邓明凤,唐元艳,等.地西他滨联合减量米托蒽醌+阿糖胞苷方案治疗复发难治性急性髓系白血病的临床疗效及安全性分析[J].中国全科医学,2016,19(6):702-705.
[10] 王贺孔,任党利,靳颖,等.急性髓系白血病患者外周血TK1和SPF的分析[J].检验医学,2017,32(10):890-893.
[11] 高雯慧,李红敏,于靖宜,等.不同挽救治疗方案对初始诱导失败和复发的急性髓系白血病患者的疗效比较[J].中国实验血液学杂志,2017,25(2):340-345.
[12] Seelan RS,Mukhopadhyay P,Pisano MM,et al.Effects of 5-Aza-2′-deoxycytidine (decitabine) on gene expression[J].Drug Metab Rev,2018,50(2):193-207.
[13] Abedin S,Platanias LC.PD1 and PDL1 upregulation and survival after decitabine treatment in lower risk MDS[J].Leuk Lymphoma,2017,58(4):764-765.
[14] 陈思思,赵彦平,吴文忠,等.地西他滨联合三氧化二砷对急性髓系白血病MV4-11细胞增殖和凋亡的影响[J].中国实验血液学杂志,2016,24(5):1343-1347.