Priming Therapy方案治疗难治复发性急性髓性白血病的临床研究

【摘要】 目的评估PrimingTherapy方案治疗复发、难治和继发性急性髓细胞白血病(AML)的疗效。方法予粒细胞集落刺激因子[(G-CSF,200μg/(m2·d),第1~14天,皮下注射)]、低剂量阿糖胞苷[(Ara-C,10mg/(m·d),d1~14,每12h皮下注射)]和阿克拉霉素[(A-cla,5~7mg/(m2·d),d1~8,静脉注射)]或高三尖杉酯碱[(HHT,1mg/(m·d),d1~8,静脉注射)]在内的PrimingTherapy方案治疗复发、难治及继发性AML患者25例。结果14例一个疗程CR,CR率56%,5例2个疗程CR,总有效率达76%,6例治疗无效,其中4例为复发病例,1例为标准常规化疗未取得缓解的病例,1例为老年低增生白血病,并可见粒细胞缺乏、血小板减少、继发感染及发热等不良反应。结论G-CSF可促进AML细胞的增殖和分化、增强化疗药物在细胞内的代谢及对白血病细胞的毒性作用,是本方案取得较高缓解率而毒副反应较少的理论基础。本方案治疗复发、难治和继发性急性髓细胞白血病安全有效。更多还原

【Abstract】 Objective To evaluate the effect of Priming Therapy regimen on acute myeloid leukemia(AML) . Methods 25 patients with AML (median age 52 , range 39～82) enrolled were treated with Priming Therapy regimen consisting of low-dose cytosine arabinoside (Ara-C , 10 mg·m -2 ·d -1 , q 12 h ; day 1 ～ 14 , subcutaneously) , aclarubicin (Acla , 5 ～ 7mg·m -2 ·d -1 ; day 1～ 8,iv) or homoharringtonine(HHT,1mg·m -2 ·d -1 ,d 1～8, iv ) , and concurrent use of granulocyte colony-stimulatingfactor ( G-CSF , 200μg·m -2 ·d -1 , subcutaneously , day 1～14) . Results 14 of 25 patients achieved complete remission , and 5 partial remission with a total remission rate of 76 %, adverse effects were agranulocytosis 、thrombocytopenia、 secondary infection and fever. Myelosuppression presenting as granulocytopenia ,complicating infection , and thrombocytopenia were the most significant toxicity in this regimen. Conclusion G-CSF enhances the proliferation and differentiation of leukemic cells , and increases the intracellular metabolism of the chemotherapeutic agents and their cytotoxity for leukemic cells. It is a safe and effective regimen in treating recurrent 、refractory and secondary Acute myelocytic leukemia.更多还原