论文部分内容阅读
目的:分析多疗程地西他滨治疗骨髓增生异常综合征(MDS)及急性髓系白血病(AML)患者的临床疗效与安全性。方法:对接受地西他滨治疗的30例MDS患者及27例AML患者进行回顾性分析。结果:地西他滨单药治疗MDS患者中,随着疗程数增加,完全缓解(CR)/骨髓完全缓解(mCR)率增加,差异有统计学意义(P=0.047)。对可能影响疗效的临床特征分析发现,在MDS患者中,重度贫血对CR/mCR有影响(P=0.042);在AML患者中,预后分层对CR/mCR有影响(P=0.016)。地西他滨治疗MDS患者相关并发症分析中,单药方案1个疗程粒细胞减少中位时间为10(0~25)d,2个疗程为6(0~24)d,3个疗程为4(0~10)d;联合方案中,1个疗程粒细胞减少中位时间为11(0~30)d,2个疗程为8(0~30)d,3个疗程为4(0~11)d;肺部感染发生率为30.0%,治疗相关死亡1例(为移植后复发)。地西他滨单药及联合方案治疗AML患者,1个疗程粒细胞减少中位时间为21(0~37)d,2个疗程为13(0~37)d,3个疗程为13(0~18)d;肺部感染发生率为40.7%,治疗相关死亡2例。通过多因素COX比例风险模型分析发现,IPSS评分及铁过载是影响MDS患者总生存的预后因素(P=0.031、0.042),而预后危险分层是影响AML患者总生存的预后因素(P=0.013)。结论:地西他滨治疗MDS/AML疗效确切,单药治疗MDS患者中,随着疗程数增加,缓解率增加;地西他滨不良事件具有可控性,安全性好,大部分患者可以安全度过化疗后骨髓抑制期。
Objective: To analyze the clinical efficacy and safety of multiple courses of citalophamin in the treatment of patients with myelodysplastic syndrome (MDS) and acute myeloid leukemia (AML). Methods: Thirty patients with MDS and 27 AML patients treated with decitabine were retrospectively analyzed. Results: In patients with MDS treated with decitabine alone, CR rate and mCR rate increased with the increase of the number of courses of treatment, the difference was statistically significant (P = 0.047). Analysis of the clinical characteristics that may affect efficacy found that severe anemia had an effect on CR / mCR in patients with MDS (P = 0.042); in AML patients, prognostic stratification had an effect on CR / mCR (P = 0.016). In the analysis of complications associated with decitabine in MDS patients, the median time to treatment for granulocytopenia in one course of treatment was 10 (0-25) days for one regimen, 6 (0-24) days for 2 courses, and 3 courses for 4 (0 ~ 10) d. In the combined regimen, the median time for one course of neutropenia was 11 (0-30) days, 2 courses were 0 (0-30) days and 3 courses were 4 11) d. The incidence of pulmonary infection was 30.0% and treatment-related death was 1 case (recurrence after transplantation). Decitabine monotherapy and combination regimen for the treatment of AML patients, a course of neutropenia median time 21 (0 ~ 37) d, 2 courses of 13 (0 ~ 37) d, 3 courses of 13 (0 ~ 18) d; the incidence of pulmonary infection was 40.7%, treatment-related death in 2 cases. According to multivariate COX proportional hazard model, IPSS score and iron overload were prognostic factors of overall survival in patients with MDS (P = 0.031,0.042), while prognostic risk stratification was the prognostic factor of overall survival in patients with AML (P = 0.013 ). CONCLUSION: Decitabine is effective in treating MDS / AML. In monotherapy MDS patients, the remission rate increases with the increase in the number of courses of treatment. The adverse events of decitabine are controllable and the safety is good. Most patients are safe Through chemotherapy after bone marrow suppression period.