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目的:观察克拉屈滨联合中剂量阿糖胞苷(Ara-C)及粒细胞集落刺激因子(G-CSG)(CLAG方案)治疗复发/难治性急性髓细胞白血病(AML)的疗效及毒副作用。方法:观察组为2012-03-2014-02治疗的18例复发/难治性AML,治疗方案:克拉屈滨5mg/m2,静脉滴注,第1~5天;Ara-C 2g/m2,静脉滴注,q12h,第1~5天;G-CSF 300μg,皮下注射,第0~5天。对照组为2010-03-2012-02用CAG方案治疗的23例复发/难治性AML。结果:CLAG治疗的18例患者中,完全缓解(CR)率50%(9/18),部分缓解(PR)率16.7%(3/18),总有效率(OR)66.7%(12/18)。疗效与CAG方案相似。CLAG方案中,年龄≤30岁患者的CR率(65.1%)显著高于>30岁组(44.6%)。而性别、外周血白细胞、骨髓原始细胞及细胞遗传学均不影响患者疗效。治疗前疾病状态也与临床疗效之间没有相关性。毒副作用主要为较强的骨髓抑制,其中粒细胞缺乏伴发热达88.9%(16/18),而胃肠道反应和肝功能受损均为轻度。无化疗相关死亡。结论:CLAG方案治疗复发/难治性AML的近期疗效较好,特别适合年龄≤30岁的年轻患者。
Objective: To observe the efficacy and toxicity of cladribine in combination with mid-dose Ara-C and granulocyte colony-stimulating factor (CLAG) in the treatment of relapsed / refractory acute myeloid leukemia (AML) side effect. Methods: 18 cases of relapsed / refractory AML treated by the observation group for 2012-03-2014-02 were treated with cladribine 5mg / m2 intravenously for 1 to 5 days; Ara-C 2g / m2, Intravenous infusion, q12h, 1st to 5th days; G-CSF 300μg, subcutaneously, 0 to 5 days. The control group was 23 relapsed / refractory AML treated with CAG regimen for the period of 2010-03-2012-02. Results: Among the 18 patients treated with CLAG, the rate of complete remission (CR) was 50% (9/18), partial remission (PR) was 16.7% (3/18) and total effective rate was 66.7% (12/18) ). Efficacy and CAG program similar. In the CLAG regimen, CR rates (65.1%) in patients ≤30 years of age were significantly higher than those in those> 30 years (44.6%). The gender, peripheral blood leukocytes, bone marrow blast cells and cytogenetics did not affect the efficacy of patients. There was no correlation between disease status and clinical outcome before treatment. Toxicity and side effects are mainly myelosuppression, in which neutropenia with fever was 88.9% (16/18), while gastrointestinal reactions and impaired liver function were mild. No chemotherapy-related death. Conclusions: CLAG regimen is effective in the treatment of relapsed / refractory AML, especially for younger patients ≤30 years of age.