地西他滨联合减量IAG方案治疗中高危骨髓增生异常综合征及其转化急性髓系白血病的临床观察

摘要

目的:分析国产地西他滨联合减量IAG方案[粒细胞集落刺激因子(G-CSF)+伊达比星(IDA)+阿糖胞苷(Ara-C)]在治疗骨髓增生异常综合征(myelodysplastic syndrome,MDS)及其转化急性髓细胞白血病(acute myeloid leukemia,AML)患者中的临床疗效及其安全性.方法:选取2014年10月至2016年5月收治的中高危MDS以及AML(MDS转化)患者共20例,应用国产地西他滨联合减量IAG方案治疗,观察临床疗效及不良反应发生情况.结果:20例患者至少进行2疗程化疗,完全缓解者9例,部分缓解5例,总有效率为70%(14/20).所有患者均出现III-IV级血液学毒性,第1、2疗程粒细胞缺乏及III、IV级血小板减少持续时间无统计学差异(P>0.05).年龄≥60岁患者粒细胞缺乏时间更长,与年龄<60岁患者相比差异有统计学意义(P<0.05),所有患者非血液学不良反应均可耐受.染色体核型预后良好者疗效佳,预后不良者预后差,患者的年龄、性别与疗效无显著相关性.结论:地西他滨联合减量IAG方案治疗MDS和AML疗效显著,不良反应可控,耐受性较好,值得在临床上进一步推广.%Objective:To investigate the clinical efficacy and adverse events of domestically produced decitabine combined with dose reduced IAG regimen[granulocyte colony stimulating factor(G-CSF),idarubicin(IDA) and cytarabine(Ara-C)]for moderate to high risk myelodysplastic syndrome(MDS) and acute myeloid leukemia(AML).Methods:Clinical data of 20 patients with MDS and AML(MDS transformation) treated with decitabine combined with dose reduced IAG regimen from Oct.2014 to May 2016 were analyzed retrospectively.The efficacy and adverse reaction were evaluated.Results:In the 20 patients,completed at least two cycles of chemotherapy,9 patients achieved complete remission,5 patients achieved partial remission and the total efficiency rate was 70%(14/20).Grade III-IV of hematologic adverse reactions occurred in all patients during the process of treatment.There was no statistically significant difference in the duration of agranulocytosis and grade Ⅲ,Ⅳ thrombocytopenia in the 1 and 2 cycles of treatment(P>0.05).Patients aged≥60 years had longer duration of granulocytopenia and had a statistically significant difference compared with patients younger than 60 years(P<0.05).All patients can withstand non hematologic adverse reactions.Those with Karyotype of good prognosis had batter efficacy than bad prognosis.Age and gender were not significantly associated with the efficacy.Conclusion:Decitabine combined with dose reduced IAG regimen in the treatment of MDS and AML can achieve satisfactory results.Adverse reactions can be controlled,worthy of further promotion in clinical practice.