MEA与FLAG方案治疗难治性复发性急性髓系白血病疗效及安全性分析

摘要

Objective To compare the efficacy and safety of MEA with FLAG in the treatment of rrAML,so as to provide reference for the treatment of rrAML. Methods 68 rrAML patients were randomly divided into 2 groups,MEA group ( n =34 ) was treated with mitoxantrone, etoposide, cytarabine;FLAG group ( n =34 ) was treated with fludarabine,cytarabine and restructuring human granulocyte colony-stimulating factor. The effect was evaluated and the incidence of adverse reactions was observed after a course of chemotherapy. Gene methylation ID4 level of complete remission( CR) of 2 groups was detected by MS-PCR,Methylight-PCR methods. Results CR rate of FLAG group was higher than that in MEA group(P<0. 05),but invasive fungal disease,agranulocytosis incidence of FLAG group were higher than that in MEA group(P<0. 05),neutropenia and fever lasting were longer than MEA group(P<0. 05). ID4 gene methylation levels in CR patients of FLAG group was lower than that in MEA group(P <0. 05). Conclusion FLAG regimen is better than MEA in the treatment of rrAML,it may be related to FLAG increasing the level of demethylation on capecitabine, but FLAG causes more serious infections and bone marrow suppression, it should be further optimized.%目的：比较MEA与FLAG方案治疗难治性复发性急性髓系白血病( rrAML)的疗效及安全性,为rrAML的治疗提供依据。方法将68例rrAML患者随机分为2组,每组34例,MEA组按照米托蒽醌+依托泊苷+阿糖胞苷方案化疗；FLAG组按照氟达拉滨+阿糖胞苷+重组人粒细胞集落刺激因子方案化疗。1个疗程后评价两组化疗效果,并观察毒副反应发生情况,对两组完全缓解( CR)者采用 MS-PCR、Methylight-PCR 检测ID4基因甲基化水平。结果 FLAG组总缓解率高于MEA组(P<0．05)；FLAG组侵袭性真菌病、粒细胞缺乏发生率高于MEA组(P<0．05),粒细胞缺乏及发热持续时间长于MEA组(P<0．05)；FLAG组CR患者ID4基因甲基化水平低于MEA组(P<0．05)。结论 FLAG方案治疗rrAML效果优于MEA方案,其机制可能与FLAG能提高地西他滨的去甲基化水平有关,但FLAG方案感染及骨髓抑制较严重,临床应进一步优化。