HAG与CAG预激方案治疗高危骨髓增生异常综合征的疗效比较

摘要

目的：比较高三尖杉酯碱( HHT)、阿糖胞苷( Ara-c)联合粒细胞集落刺激因子( G-CSF)的小剂量预激化疗方案( HAG方案)与阿克拉霉素( aclacinomycin)、Ara-c联合G-CSF的CAG方案治疗高危骨髓增生异常综合征( MDS)的效果及其安全性。方法52例初诊的高危MDS患者入选HAG方案组,50例初诊的高危MDS患者入选CAG组。1个疗程后初步评价疗效,未缓解者进行第2个疗程,2个疗程后评价治疗效果及不良反应。结果①HAG组2疗程后共25例获完全缓解( CR)(48.1%),11例获部分缓解(PR)(21.2%),总有效率69.2%。 CAG组2疗程后23例获CR(46.0%),9例获PR(18.0%),总有效率64.0%。经统计学检验,HAG与CAG方案组比较无统计学差异。②HAG组在诱导治疗期间发生粒细胞缺乏的比例为53.8%(28例),平均持续时间4 d,血小板<20×109/L的比例为34.6%(18例),平均持续时间5 d；CAG组诱导治疗期间发生粒细胞缺乏的比例为58.0%(29例),平均持续时间6 d,血小板<20×109/L的比例为38.0%(19例),平均持续时间7 d。%Objective To compare the efficacy and safety of low-dose priming regimens, HAG [ homoharringtonine, cytarabine and granulocyte colony-stimulating factor( G-CSF) ] versus CAG( aclacinomycin, cytarabine and G-CSF) for the patients with high-risk my-elodysplastic syndrome( MDS) . Methods Fifty-two newly diagnosed adult patients with high-risk MDS were enrolled and treated with the HAG regimen, and fifty newly diagnosed patients with high-risk MDS were enrolled and treated with the CAG regimen. The efficacy was evaluated after a cycle, and the non-remission patients were given a second cycle and then the efficacy and the side effects were e-valuated. Results ①A total of 25 patients(48. 1%) achieved complete response(CR) and 11 patients(21. 2%) achieved partial re-sponse(PR) after two courses of HAG regimen, and the total effective rate was 69. 2%. A total of 23 patients(46. 0%) achieved CR and 9 patients(18. 0%) achieved PR after two courses of CAG regimen, and the total effective rate was 64. 0%. There was no statistical difference in the effective rate between HAG and CAG.②In the induction therapy of HAG regimen, a total of 28 patients(53. 8%) ex-perienced neutropenia(median duration:4 d), and 18 patients(34. 6%) experienced platelets less than 20 × 109/L(median duration:5 d). In the CAG regimen, a total of 29 patients(58. 0%) experienced neutropenia(median duration:6 d), and 19 patients(38. 0%) experienced platelets less than 20 × 109/L( median duration:7 d) . Conclusion The low-dose HAG chemotherapy regimen is as ef-fective as CAG regimen in induction therapy for high-risk MDS, with slight myelosuppression and nonhematologic toxicities.