【摘要】 目的探讨去甲基化药物地西他滨联合小剂量IA(去甲氧柔红霉素+阿糖胞苷)方案治疗老年急性髓系白血病患者的临床疗效。方法选取2016年10月至2020年7月浙江省人民医院收治的老年急性髓系白血病患者72例。其中38例患者采用地西他滨联合小剂量IA方案治疗,为观察组;另34例采用小剂量IA方案治疗,为对照组。观察并比较两组患者临床疗效、不良反应发生情况及预后,分析患者总生存期影响因素。结果治疗1个疗程及4～6个疗程后,观察组患者治疗总有效率均高于对照组(73.68%比47.06%、76.92%比43.75%,均P<0.05)。观察组患者肺部感染、骨髓抑制、恶心、呕吐及肝肾功损害等不良反应发生率比较差异均无统计学意义(52.63%比47.06%、81.58%比64.71%、60.53%比52.94%、10.53%比8.82%,均P>0.05)。患者染色体核型差异、治疗方案差异是影响患者总生存期的因素。与对照组相比,观察组患者中位总生存期、中位无进展生存期均明显改善(15个月比10个月、9.61个月比6.06个月,均P<0.05)。结论去甲基化药物地西他滨联合小剂量IA方案治疗老年急性髓系白血病患者临床疗效确切,未增加不良反应发生率,值得临床借鉴。更多还原

【Abstract】 Objective To investigate the efficacy of decitabine combined with low-dose IA regimen(cyclophosphamide combined with cytarabine) in treatment of elderly patients with acute myeloid leukemia. Methods Clinical data of 72 elderly patients with acute myoloid leukemia admitted to Zhejiang Provincial People’s Hospital from October 2016 to July 2020 were retrospectively analyzed, including 38 patients receiving demethylation drugs(decitabine) based on the low-dose IA regimen(study group) and 34 patients receiving IA regimen(control group). The clinical efficacy, adverse reactions and prognosis of patients were compared between the two groups and the factors affecting the overall survival(OS) of the patients were analyzed.Results After 1 and 4-6 courses of treatment, the overall response rate of the study group was significantly higher than that of the control group(73.68% vs. 47.06%, 76.92% vs. 43.75% P<0.05). During the treatment, there was no significant difference in the incidence of infection,bone marrow suppression, nausea, vomiting, liver and renal dysfunction between the two groups(52.63% vs. 47.06%、81.58% vs. 64.71%、60.53% vs. 52.94%、10.53% vs. 8.82%, P >0.05). Logistic regression analysis showed that the cytogenetic abnormalities and regimes were independent prognostic factors of OS(P<0.05). The median OS and the median PFS of study group was significantly longer than those of control group(15 months vs 10 months, 9.61 months vs 6.06 months, P<0.05). Conclusion Compared to IA regime, the combination of decitabine with low-dose IA regimen is more effective without increasing the incidence of adverse reactions in treatment of elderly patients with acute myeloid leukemia.更多还原