分析地西他滨联用IAG方案治疗老年MDS转化为急性髓系白血病患者的实际效果
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摘要
目的探讨老年骨髓增生异常综合征(MDS)转化为急性髓系白血病(AML)患者采取地西他滨与预激改良方案(IAG)联合治疗的实际效果,以便为临床治疗提供参考。方法选择本院2009年1月至2017年12月收治的50例老年MDS转化为AML患者作为研究对象,入组对象有完整资料,愿意配合研究且签署了知情同意书。所有患者均接受地西他滨与预激改良方案联合治疗,两组患者均治疗≥2个疗程,且均随访半年以上。治疗2个疗程后评价疗效,记录不良反应(对两个疗程期间不良反应进行比较分析),同时根据治疗有效与无效分组,比较两组性别、年龄、预后FLT3基因、染色体核型差异性。结果本次研究50例患者经2个疗程治疗后评价疗效,显示完全缓解18例、部分缓解22例、未缓解10例,有效率80.00%;经统计学分析有效组与无效组患者性别、年龄、预后FLT3基因、染色体核型可以看出,两组在预后FLT3基因上差异有统计学意义(P<0.05),其余差异无统计学意义;治疗第1个疗程时,感染率高达84.00%,治疗第2个疗程时感染率为70.00%,2个疗程感染率表差异有统计学意义(P<0.05),但其余如骨髓抑制、恶心呕吐、背部疼痛不适、肝功能损伤比较差异无统计学意义。结论地西他滨与预激改良方案联合治疗MDS转化为急性髓系白血病患者有一定的效果,随着疗程增加,安全性提高,主要不良反应为感染、骨髓抑制,对症处理后缓解或消失,同时其疗效可能和预后FLT3基因有关,在实际治疗期间需加强重视。
Objective To investigate the effect of combination therapy of dietabine and(IAG) in elderly patients with myelodysplastic syndrome(MDS) converted into acute myeloid leukemia(AML) in order to provide reference for clinical treatment. Methods 50 elderly patients with MDS converted into AML from January 2009 to December 2017 were selected as the study objects. The subjects were willing to cooperate with the study and sign the informed consent. All patients were treated with combination of dietabine and preexcitation regimen. Both groups were treated with more than 2 courses of treatment and were followed up. More than half a year. After two courses of treatment, we evaluated the curative effect, recorded the adverse reactions(compared and analyzed the adverse reactions during the two courses of treatment), and compared the sex, age, prognosis of FLT3 gene and chromosome karyotype difference between the two groups according to the effective and ineffective groups. Results After two courses of treatment, 50 patients in this study were evaluated for their curative effects, including 18 cases of complete remission, 22 cases of partial remission, 10 cases of non-remission, the effective rate was 80.00%. The effective group and ineffective group were of gender, age, and age. Prognostic FLT3 gene, chromosome karyotype can be seen, the two groups in the prognosis of FLT3 gene differences are significant. The infection rate in the first course of treatment was as high as 84.00 and the infection rate in the second course of treatment was 70.00%.The infection rate of the two courses was significantly different(P<0.05), but the rest were as follows: bone marrow depression, nausea and vomiting. There was no difference in back pain and liver function injury. Conclusion The combination of dicitabine and preexcitation regimen is effective in the treatment of patients with acute myeloid leukemia from MDS to acute myeloid leukemia. With the increase of course of treatment, the safety is improved. The main adverse reactions are infection and bone marrow suppression. The therapeutic effect may be related to the prognosis of FLT3 gene and should be paid more attention to during the actual treatment.
Objective To investigate the effect of combination therapy of dietabine and(IAG) in elderly patients with myelodysplastic syndrome(MDS) converted into acute myeloid leukemia(AML) in order to provide reference for clinical treatment. Methods 50 elderly patients with MDS converted into AML from January 2009 to December 2017 were selected as the study objects. The subjects were willing to cooperate with the study and sign the informed consent. All patients were treated with combination of dietabine and preexcitation regimen. Both groups were treated with more than 2 courses of treatment and were followed up. More than half a year. After two courses of treatment, we evaluated the curative effect, recorded the adverse reactions(compared and analyzed the adverse reactions during the two courses of treatment), and compared the sex, age, prognosis of FLT3 gene and chromosome karyotype difference between the two groups according to the effective and ineffective groups. Results After two courses of treatment, 50 patients in this study were evaluated for their curative effects, including 18 cases of complete remission, 22 cases of partial remission, 10 cases of non-remission, the effective rate was 80.00%. The effective group and ineffective group were of gender, age, and age. Prognostic FLT3 gene, chromosome karyotype can be seen, the two groups in the prognosis of FLT3 gene differences are significant. The infection rate in the first course of treatment was as high as 84.00 and the infection rate in the second course of treatment was 70.00%.The infection rate of the two courses was significantly different(P<0.05), but the rest were as follows: bone marrow depression, nausea and vomiting. There was no difference in back pain and liver function injury. Conclusion The combination of dicitabine and preexcitation regimen is effective in the treatment of patients with acute myeloid leukemia from MDS to acute myeloid leukemia. With the increase of course of treatment, the safety is improved. The main adverse reactions are infection and bone marrow suppression. The therapeutic effect may be related to the prognosis of FLT3 gene and should be paid more attention to during the actual treatment.
引文
[1]黄月琴,张学亚,吴诗馨,等.地西他滨联合IAG方案治疗老年MDS转化为急性髓系白血病患者的疗效观察[J].中国实验血液学杂志,2017,25(6):1641-1646.
[2]管俊,姜扬文,孙爱红,等.地西他滨联合半量预激方案对老年急性髓性白血病及高危骨髓增生异常综合征的影响[J].中华临床医师杂志,2014,17(21):3897-3900.
[3]李光,任婧婧,张韵洁,等.地西他滨联合减量IAG方案治疗中高危骨髓增生异常综合征及其转化急性髓系白血病的临床观察[J].现代肿瘤医学,2017,25(18):2985-2989.
[4]邱媛媛,管俊,吴玉梅,等.地西他滨治疗老年急性髓性白血病及高危骨髓增生异常综合征的护理[J].大家健康,2016,10(12):190-190,191.
[5]秦茹娟,徐茂忠,陈纬凤,等.地西他滨治疗急性髓系白血病/骨髓增生异常综合征继发血小板增多症6例临床观察[J].交通医学,2017,31(6):533-535.
[6]高苏,仇惠英,金正明,等.地西他滨单药及联合半程和全程CAG方案治疗骨髓增生异常综合征和急性髓系白血病疗效观察[J].中华血液学杂志,2014,35(11):961-965.
[7]张之南,沈悌.血液病诊断与疗效标准[M].北京:科学出版社,2008:99-163.
[8]吴东,张耀,赵佑山,等.地西他滨对MDS-L细胞增殖的抑制作用及其相关作用机制研究[J].中国实验血液学杂志,2017,25(5):1471-1476.
[9]杨波,蔡力力,汪海涛,等.超低剂量地西他滨联合自体CIK细胞输注治疗骨髓增生异常综合征转化的高龄急性髓细胞白血病1例并文献复习[J].解放军医学杂志,2014,39(4):315-319.
[10]周进,王婧,刘辉,等.含地西他滨方案桥接异基因造血干细胞移植治疗MDS/AML的效果评估[J].中华医学杂志,2015,95(12):920-924.
[11]王萌,韩好好,郭荣,等.低剂量地西他滨序贯CAG方案治疗MDS-难治性贫血伴有原始细胞过多的临床疗效[J].中国实验血液学杂志,2017,25(5):1482-1486.
[12]任杰,郭慧梅,庞艳彬,等.地西他滨在骨髓增生异常综合征和急性髓白血病中的免疫机制[J].国际免疫学杂志,2018,41(1):100-104.
[13]郑慧菲,王婧,周进,等.地西他滨桥接异基因造血干细胞移植治疗骨髓增生异常综合征的疗效分析[J].中华血液学杂志,2015,36(2):121-124.
[14]邱宗建,杨娟,宋强,等.地西他滨对同步化的G0/G1期MDS-L细胞系线粒体功能的影响[J].山东大学学报(医学版),2014,14(5):5-9.
[15]叶丽,任艳玲,谢丽丽,等.小剂量地西他滨治疗较低危骨髓增生异常综合征患者疗效初步观察[J].中华血液学杂志,2017,38(4):307-312.
[16]钟樱红,罗华山,黎民君,等.自体外周血造血干细胞和自体骨髓移植治疗急性髓性白血病的临床研究[J].当代医学,2015,15(11):20-21.
[2]管俊,姜扬文,孙爱红,等.地西他滨联合半量预激方案对老年急性髓性白血病及高危骨髓增生异常综合征的影响[J].中华临床医师杂志,2014,17(21):3897-3900.
[3]李光,任婧婧,张韵洁,等.地西他滨联合减量IAG方案治疗中高危骨髓增生异常综合征及其转化急性髓系白血病的临床观察[J].现代肿瘤医学,2017,25(18):2985-2989.
[4]邱媛媛,管俊,吴玉梅,等.地西他滨治疗老年急性髓性白血病及高危骨髓增生异常综合征的护理[J].大家健康,2016,10(12):190-190,191.
[5]秦茹娟,徐茂忠,陈纬凤,等.地西他滨治疗急性髓系白血病/骨髓增生异常综合征继发血小板增多症6例临床观察[J].交通医学,2017,31(6):533-535.
[6]高苏,仇惠英,金正明,等.地西他滨单药及联合半程和全程CAG方案治疗骨髓增生异常综合征和急性髓系白血病疗效观察[J].中华血液学杂志,2014,35(11):961-965.
[7]张之南,沈悌.血液病诊断与疗效标准[M].北京:科学出版社,2008:99-163.
[8]吴东,张耀,赵佑山,等.地西他滨对MDS-L细胞增殖的抑制作用及其相关作用机制研究[J].中国实验血液学杂志,2017,25(5):1471-1476.
[9]杨波,蔡力力,汪海涛,等.超低剂量地西他滨联合自体CIK细胞输注治疗骨髓增生异常综合征转化的高龄急性髓细胞白血病1例并文献复习[J].解放军医学杂志,2014,39(4):315-319.
[10]周进,王婧,刘辉,等.含地西他滨方案桥接异基因造血干细胞移植治疗MDS/AML的效果评估[J].中华医学杂志,2015,95(12):920-924.
[11]王萌,韩好好,郭荣,等.低剂量地西他滨序贯CAG方案治疗MDS-难治性贫血伴有原始细胞过多的临床疗效[J].中国实验血液学杂志,2017,25(5):1482-1486.
[12]任杰,郭慧梅,庞艳彬,等.地西他滨在骨髓增生异常综合征和急性髓白血病中的免疫机制[J].国际免疫学杂志,2018,41(1):100-104.
[13]郑慧菲,王婧,周进,等.地西他滨桥接异基因造血干细胞移植治疗骨髓增生异常综合征的疗效分析[J].中华血液学杂志,2015,36(2):121-124.
[14]邱宗建,杨娟,宋强,等.地西他滨对同步化的G0/G1期MDS-L细胞系线粒体功能的影响[J].山东大学学报(医学版),2014,14(5):5-9.
[15]叶丽,任艳玲,谢丽丽,等.小剂量地西他滨治疗较低危骨髓增生异常综合征患者疗效初步观察[J].中华血液学杂志,2017,38(4):307-312.
[16]钟樱红,罗华山,黎民君,等.自体外周血造血干细胞和自体骨髓移植治疗急性髓性白血病的临床研究[J].当代医学,2015,15(11):20-21.