地西他滨联合减量MA/DA方案治疗复发难治性急性髓系白血病临床观察

摘要

目的：观察地西他滨联合减量MA/DA方案治疗复发难治性急性髓系白血病患者的疗效及安全性。方法选取2012年8月至2015年6月本院收治的18例复发难治性急性髓系白血病患者，予以地西他滨联合减量MA [地西他滨20 mg/(m2· d)，d1~5；米托蒽醌8~12 mg/m2，d6~8；阿糖胞苷100 mg/m2，d6~8]/DA方案[地西他滨20 mg/(m2· d)，d1~5；柔红霉素40~45 mg/m2，d6~8；阿糖胞苷100 mg/m2，d6~8]，观察患者临床疗效及不良反应。结果18例患者中完全缓解(CR)6例(33.3%),部分缓解(PR)5例(27.8%)，总有效率(ORR)为61.1%；8例染色体异常患者治疗后1例获完全细胞遗传学缓解，3例部分细胞遗传学缓解，总有效率为50.0%。不良反应主要为骨髓抑制及继发感染，经过输血和抗感染等支持治疗均可以耐受。随访至2015年6月，患者中位生存为8个月。结论地西他滨联合减量MA/DA方案治疗复发难治性急性髓系白血病在血液学及细胞遗传学上可以获得较好疗效，且毒副作用较轻，耐受性良好。%Objective To investigate the clinical efficacy and safety of decitabine combined with the reduced quantity of cytarabine (Ara-C) and mitoxantrone (MIT) regimen in the treatment of patients with refractory or re-lapsed acute myeloid leukemia. Methods Eighteen cases with refractory or relapsed acute myeloid leukemia in our hospital from August 2012 to June 2015 were treated with decitabine combined with reduced quantity of MA regimen (decitabine 20 mg/(m2· d), d1~5; MIT 8~12 mg/m2, d6~8;Ara-c100 mg/m2, d6~8)/DA regimen (decitabine 20 mg/(m2· d), d1~5; DNR 40~45 mg/m2, d6~8;Ara-c100 mg/m2, d6~8), and the clinical outcome and adverse events were recorded. Results Among 18 patients, 6 (33.3%) patients achieved complete remission (CR), and 5 (27.8%) were partial remission (PR), with overall remission rate (ORR) of 61.1%;After treatment, of 8 patients with chromosomal ab-normalities, 1 patient achieved complete cytogenetic remission, 3 patients were partial cytogenetic remission, and the over-all response rate was 50.0%. Adverse events mainly include myelosuppression and secondary infection, which could be well tolerated with the help of blood transfusions and anti-infection supportive treatment. Following up to June 2015, the median overall survival (OS) was 8 months. Conclusion Decitabine combined with the reduced quantity of MA/DA regi-men is effective and well tolerated in the treatment of patients with refractory or relapsed acute myeloid leukemia.