首都医科大学学报 ›› 2019, Vol. 40 ›› Issue (2): 300-304.doi: 10.3969/j.issn.1006-7795.2019.02.026

• 临床研究 • 上一篇    下一篇

地西他滨序贯或同时联合“3+7”方案在45例初发急性髓系白血病中治疗效果分析

彭晓娟, 张睿娟, 王梅芳, 张耀方, 覃艳红, 杨林花   

  1. 山西医科大学第二医院血液科, 太原 030001
  • 收稿日期:2018-11-15 出版日期:2019-03-21 发布日期:2019-04-15
  • 通讯作者: 张睿娟 E-mail:13593169668@163.com
  • 基金资助:
    山西省应用基础研究项目(201801D121328)。

Clinical efficacy of decitabine sequential or simultaneous with “3+7” regimen for acute myeloid leukemia

Peng Xiaojuan, Zhang Ruijuan, Wang Meifang, Zhang Yaofang, Tan Yanhong, Yang Linhua   

  1. Department of Hematology, The Second Hospital of Shanxi Medical University, Taiyuan 030001, China
  • Received:2018-11-15 Online:2019-03-21 Published:2019-04-15
  • Supported by:
    This study was supported by Applied Basic Research Project of Shanxi(201801D121328).

摘要: 目的 探讨地西他滨(decitabine,DAC)不同时间点联合标准诱导方案治疗初发急性髓系白血病(acute myeloid leukemia,AML)的治疗效果与安全性。方法 回顾性分析2012年6月至2018年3月收治的45例初治急性髓系白血病接受地西他滨联合"3+7"方案治疗的临床资料,其中序贯组29例,同时用药组16例,比较2组患者的治疗效果、生存期及不良反应等。结果 45例患者总有效率(overall response rate,ORR)[完全缓解(complete response,CR)+形态学CR伴不全血象恢复(CR with incomplete hematological recovery,CRi)+部分缓解(partial response,PR)]达75.56%;其中CR/CRi率为55.6%(25/45);序贯组与同时用药组的ORR分别为75.9%与75.0%,差异无统计学意义(χ2=0.595,P=0.842)。治疗≥ 4个疗程的患者共24例,ORR达91.7%;序贯组17例,ORR为94.1%;同时用药组7例,ORR为85.7%。中位随访时间8个月,序贯组与同时用药组的总生存(overall survival,OS)分别为(7.25±4.61)个月vs(8.48±5.42)个月(P=0.447)。两组最常见的不良反应为3级及以上血细胞减少和感染,以呼吸道感染最为常见,在治疗早期(第1~2疗程)较常见。首次诱导治疗结束后,序贯组3~4级骨髓抑制时间较同时用药组延长,主要表现为粒细胞缺乏,分别为15.0 d vs 8.5 d(P<0.001);序贯组肛周、胃肠道以及皮肤软组织感染发生率较高,红细胞及血小板输注量也较同时用药组高,但差异无统计学意义(P>0.05)。结论 地西他滨序贯或同时联合标准诱导方案疗AML的治疗效果相当,但同时用药组安全性较好,骨髓抑制期短、血细胞输注量较少,感染发生率较低。

关键词: 急性髓系白血病, 地西他滨, 骨髓抑制

Abstract: Objective To compare the clinical efficacy and safety among decitabine combined standard induction regimen at different time points in treatment of acute myeloid leukemia(AML).Methods The clinical data of 45 AML patients enrolled from June 2012 to March 2018 were collected.The differences of clinical outcome and adverse events among the patients treated with decitabine sequentially or simultaneously with "3+7" regimen were analyzed. Results For 45 patients,the overall response rate (ORR)[complete response (CR)+CR with incomplete hematological recovery (CRi)+partial response (PR)] was 75.56%,CR/CRi was up to 55.6%(25/45);The ORR in the sequential and simultaneous group was 75.9% and 75.0%, respectively.However,there is no significant difference was observed among the two groups (P=0.842).Median followed-up time was 8 months,the overall survival(OS)of sequential group and simultaneous group was (7.25±4.61) months vs (8.48±5.42) months(P=0.447).Adverse events in the two groups were similar, mainly including cytopenia and infection,which were more common in the early stages of treatment. After the first induction treatment, the 3/4 grade myelosuppression time in the sequential group was longer than that in the simultaneous treatment group, mainly manifested as agranulocytosis, which was 15.0 d vs 8.5 d (P<0.001),and the incidence of perianal, gastrointestinal and skin and soft tissue infection was increased.The median number of suspended red blood cells and platelet infused was higher in the sequential group(P>0.05).Conclusion Whenever in sequential group or simultaneous group,the induction efficacy of decitabine combined with chemotherapy were similar,but the simultaneous group had better safety, the duration of myelosuppression was shorter, mainly manifested as shortening of the granulosis period, less blood cell infusion, and a lower incidence of infection.

Key words: acute myeloid leukemia(AML), decitabine(DAC), myelosuppression

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