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目的探讨小剂量地西他滨联合G-HA预激方案治疗高危骨髓增生异常综合征(MDS)的临床疗效和安全性。方法应用小剂量地西他滨联合G-HA预激方案治疗24例初诊高危MDS患者,方案采用:地西他滨10mg/d,静脉滴注,第1~5天;G-HA预激方案包括:高三尖杉酯碱(HHT)1mg/d,静脉滴注,第1~14天,阿糖胞苷(Ara-c)10mg,1次/12h,皮下注射,第1~14天,粒细胞集落刺激因子(G-CSF)300μg,皮下注射,化疗前1天开始,持续使用至化疗结束或外周血白细胞计数>20×109/L。观察临床疗效和不良反应,并进行随访。结果 24例中有16例(66.7%)患者获得完全缓解(CR),3例(12.5%)患者获得部分缓解(PR),总有效率79.2%。在诱导治疗期间发生粒细胞缺乏的比例为75.0%(18例),平均持续时间8天;血小板<20×10~9/L的比例为70.8%(17例),平均持续时间7天;非血液系统不良反应轻微,无早期死亡病例,平均随访时间28个月;平均总生存期(OS)为26个月;平均无病生存期(DFS)为13个月。结论小剂量地西他滨联合G-HA预激方案治疗高危MDS缓解率高,不良反应轻,优于单用地西他滨或单用预激方案,可作为临床治疗MDS的首选方案。
Objective To investigate the clinical efficacy and safety of low-dose decitabine plus G-HA pre-shock regimen in the treatment of high-risk myelodysplastic syndrome (MDS). Methods 24 cases of newly diagnosed high-risk MDS patients were treated with low-dose decitabine combined with G-HA pre-shock regimen. The regimen consisted of decitabine 10 mg / d, intravenous drip for 1 to 5 days. Including: homoharringtonine (HHT) 1mg / d, intravenous drip, the first to 14 days, cytarabine (Ara-c) 10mg, 1 / 12h, subcutaneous injection, the first to 14 days, 300 μg of G-CSF was administered subcutaneously, one day before chemotherapy and continued until the end of chemotherapy or peripheral blood leukocyte count> 20 × 109 / L. Clinical efficacy and adverse reactions were observed and followed up. Results Of the 24 patients, 16 (66.7%) achieved complete remission (CR) and 3 (12.5%) achieved partial response (PR) with a total effective rate of 79.2%. The percentage of agranulocytosis during induction therapy was 75.0% (18 cases) with an average duration of 8 days. The proportion of platelets with 20 × 10 ~ 9 / L was 70.8% (17 cases) with an average duration of 7 days. Adverse reactions to the blood system were mild with no early deaths, with a mean follow-up of 28 months; mean overall survival (OS) of 26 months; mean disease-free survival (DFS) of 13 months. Conclusions Low-dose decitabine combined with G-HA pre-shock regimen has a high response rate and mild adverse reactions to high-risk MDS. It is superior to decitabine alone or single-use pre-shock regimen and may be the first choice for clinical treatment of MDS.