【摘要】 目的观察老年复发难治急性髓系白血病患者接受小剂量地西他滨联合预激方案化疗(CAG,低剂量阿糖胞苷+阿克拉霉素+粒细胞集落刺激因子)的疗效。方法选取2015年6月至2017年6月河南省人民医院血液科的28例老年复发/难治急性髓细胞白血病(AML)患者,随机分为两组。小剂量地西他滨+CAG组(观察组) 15例,CAG组(对照组) 13例。两组患者在治疗1个疗程结束后若未缓解则继续应用1个疗程,2个疗程后评价疗效及不良反应发生情况。比较两组患者的治疗效果及药物不良反应发生情况。结果接受小剂量地西他滨联合CAG方案的患者,完全缓解(CR) 3例,部分缓解(PR) 7例,未缓解(NR) 5例,总缓解率(ORR)为66. 67%(10/15);仅接受CAG方案的13例患者,CR2例,PR2例,NR9例,ORR 30. 77%(4/13)(P=0. 261)。地西他滨+CAG组中位总生存期(OS)为18个月,CAG组中位OS为10个月,两组比较差异有统计学意义(P=0. 044)。治疗后,两组患者耐受性均较好,主要表现为胃肠道反应。无患者出现肝脏损伤。结论低剂量地西他滨+CAG方案用于老年AML治疗的疗效确切,总体生存时间较单用CAG方案有一定的延长。且不良反应基本可控,是临床上值得进一步推广和应用的方案。更多还原

【Abstract】 Objective To observe the therapeutic effect of low dose of desetabine plus pre excitation chemotherapy( CAG,low dose cytarabine + aclacinomycin + granulocyte colony stimulating factor) on elderly patients with relapsed and refractory acute myeloid leukemia. Methods From June 2015 to June 2017,28 elderly patients with relapsed/refractory acute myeloid leukemia( AML) were randomly divided into two groups. There were 15 cases in the group of low-dose dessicabine + CAG( observation group) and 13 cases in the group of CAG( control group). After one course of treatment,if there is no remission,the patients in the two groups will continue to use one course of treatment. After two courses of treatment,the efficacy and adverse reactions will be evaluated. The therapeutic effects and adverse drug reactions of the two groups were compared. Results Among the patients who received low-dose dessicabine combined with CAG regimen,3 cases were CR3,7 cases were PR7,5 cases were NR,and 66. 67% of the cases were ORR. Only 13 patients who received CAG regimen,2 cases were CR2,2 cases were PR2,9 cases were NR,and 30. 77% of the cases were ORR( P = 0. 261). The median OS was 18 months in the digitabine +CAG group and 10 months in the CAG group. The difference between the two groups was significant( P =0. 044). After treatment,the tolerance of the two groups was better,mainly manifested as gastrointestinal reaction. There was no liver injury. Conclusions The therapeutic effect of low dose desetabine plus CAG on elderly AML is definite,and the overall survival time is longer than that of CAG alone. And the side effects are basically controllable,which is worthy of further promotion and application.更多还原