Objective To observe the efficacy and side effects of low - density regimen CHG ( Hydroxy camptothecin, Cytarabine, and granulocyte colony - stimulating factor ) as a priming induction regimen in the treatment of patients with high -risk myelodysplasia syndrome ( MDS ) or MDS - transformed acute myeloid leukemia ( AML ), and to compare the results with those of CAG regimen ( Aclacimomycin, Cytarabine and granulocyte colony - stimulating factor ). Methods Patients with high - risk MDS or MDS - transformed AML who had not undergone chemotherapy were divided into the CHG group ( n = 32; CHG regimen as induction therapy ) and the CAG group ( n = 29; CAG regimen as induction therapy ). The efficacy and side effects after one course of chemotherapy were observed and compared between the two regimens. Results After one course of treatment, the total effective rate of the CHG group was 68. 8% , with 14 patients achieving complete remission ( CR ), 7 partial remission ( PR ), and 1 with hematological response; while the total effective rate of the CAG group was 72. 4% , with 12 patients achieving CR, 6 PR and 3 with hematological response. No significant difference was found between the two groups in rate of CR, total effective rate, and side effects ( P >0. 05 ). During follow - up, 3 out of 14 cases of the CHG group who were followed by the Harringtonine + Ara - c ( HA ) or Etoposide + Ara - c ( EA ) maintenance therapy due to cardiac arrhythmia relapsed after CR. Out of the 14 cases, 11 cases were alternately treated with HA, Aclacimomycin + Ara - c ( AA ), Topotecan + Ara - c ( TA ), Mitoxantrone + Ara - c ( MA ), and Idamycin + Ara - c ( IA ) regimens, with 7 cases relapsed within 3-16 months, 3 cases transformed into AML, and 1 case lost to follow - up. Two out of 4 cases who relapsed after more than 6 months of remission achieved CR, but relapsed afterwards. Out of the 12 cases in the CAG group who reached CR, 8 patients relapsed within 2. 6 ~ 17 months, 2 transformed into AML, and 2 lost to follow - up. Five out of 8 relapsed cases were induced with CAG regimen but did not achieve CR; while 3 out of 8 relapsed cases were induced with CHG regimen and achieved 1 case of CR and 1 case of PR. Conclusion The CHG chemotherapy regimen is safe and effective in the treatment of moderate - and high - risk MDS. Consolidation therapy with alternate multi - regimens is necessary for patients achieving CR to avoid early relapse.%目的 观察含羟基喜树碱的低强度化疗CHG(羟基喜树碱、阿糖胞苷和粒细胞集落刺激因子)预激方案诱导治疗高危骨髓增生异常综合征(MDS)及MDS转化的急性髓系白血病(AML)的疗效和毒副作用及其与CAG(阿克拉霉素、阿糖胞苷和粒细胞集落刺激因子)方案的比较.方法 按自愿原则选择32例(CHG组)未接受化疗的高危MDS及MDS转化的AML患者给予CHG方案诱导治疗;29例(CAG组)未接受化疗的高危MDS及MDS转化的AML患者给予CAG方案诱导治疗,观察并比较1个疗程后两组患者的临床疗效及毒副作用.结果 1个疗程结束后,CHG组患者中完全缓解(CR)14例,部分缓解(PR)7例,血液学改善1例,总有效率68.8%;CAG组患者中CR 12例,PR 6例,血液学改善3例,总有效率72.4%.两组的CR率和总有效率比较,差异均无统计学意义(P＞0.05).两组各项毒副作用发生情况比较,差异亦均无统计学意义(P＞0.05).随访发现,CHG组14例CR患者中3例因心律失常仅接受HA(三尖杉酯碱+阿糖胞苷)/EA(足叶乙甙+阿糖胞苷)方案巩固及强化,已全部复发.11例患者交替接受HA/AA(阿克拉霉素+阿糖胞苷)/TA(拓扑替康+阿糖胞苷)/MA(米托蒽醌+阿糖胞苷)/IA(去甲氧柔红霉素+阿糖胞苷)等方案化疗,1例失访,7例分别在3~16个月复发,3例进展为AML;4例缓解期超过6个月的复发患者中有2例取得CR,很快再次复发.CAG组12例CR患者,2例失访,8例分别在2.6~17个月复发,2例进展为AML.5例复发患者再用CAG方案,未取得CR,3例应用CHG方案,1例取得CR,1例取得PR.结论 CHG方案治疗中高危MDS和MDS转化的AML安全有效,CR后应强化治疗或多种方案交替治疗,避免早期复发.
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