地西他滨单药与CAG/HAG方案治疗难治性贫血伴有原始细胞增多的疗效和安全性比较

【摘要】目的比较地西他滨(DAC)单药与以小剂量阿糖胞苷(Ara.C)为基础的CAG/HAG(阿克拉霉素/高二三尖杉酯碱+Ara-C+G—CSF)方案治疗骨髓增生异常综合征(MDS)难治性贫血伴有原始细胞增多(RAEB)的疗效及安全性。方法回顾性分析2008年12月至2016年10月中国医学科学院血液病医院MDS诊疗中心121例MDS—RAEB患者临床资料,其中59例接受DAC20mg·m^-2·d^-1×5d方案治疗,62例接受CAG/HAG方案治疗,比较两组患者的总反应率(0RR)、总生存(OS)率及不良反应发生率。结果DAC组、CAG/HAG组患者的ORR分别为66.2%和56.4%,差...

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Published in中华血液学杂志 Vol. 38; no. 7; pp. 572 - 577
Main Author 徐泽锋 秦铁军 张宏丽 方力维 张悦 潘丽娟 胡耐博 曲士强 李冰 肖志坚
Format Journal Article
LanguageChinese
Published 300020 天津,中国医学科学院、北京协和医学院血液学研究所、血液病医院,实验血液学国家重点实验室 2017
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ISSN0253-2727
DOI10.3760/cma.j.issn.0253-2727.2017.07.004

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Summary:【摘要】目的比较地西他滨(DAC)单药与以小剂量阿糖胞苷(Ara.C)为基础的CAG/HAG(阿克拉霉素/高二三尖杉酯碱+Ara-C+G—CSF)方案治疗骨髓增生异常综合征(MDS)难治性贫血伴有原始细胞增多(RAEB)的疗效及安全性。方法回顾性分析2008年12月至2016年10月中国医学科学院血液病医院MDS诊疗中心121例MDS—RAEB患者临床资料,其中59例接受DAC20mg·m^-2·d^-1×5d方案治疗,62例接受CAG/HAG方案治疗,比较两组患者的总反应率(0RR)、总生存(OS)率及不良反应发生率。结果DAC组、CAG/HAG组患者的ORR分别为66.2%和56.4%,差异无统计学意义(x^2=1.185,P=0.276)。CAG/HAG组1个疗程起效率明显高于DAC组(94.3%对69.2%),两组患者起效疗程数总体比较差异有统计学意义(x^2=7.612,P=0.009)。DAC组中位OS时间为19.5(95%CI10.5~28.4)个月,CAG/HAG组中位0s时间为20.3(95%CI10.7~29.9)个月,两组差异无统计学意义(x^2=0.004,Jp=0.947)。两组患者的不良反应主要是3~4级血细胞减少和相关感染,CAG/HAG组血细胞减少发生率明显高于DAC组(100.0%对64.4%,P〈0.001),CAG/HAG组第3个疗程相关感染发生率明显高于DAC组(52.9%对15.2%,P=0.008)。结论DAC单药和CAG/HAG治疗MDS.RAEB的疗效相当,CAG/HAG方案起效更快,DAC单药治疗安全性更好。
Bibliography:Objective To observe the clinical efficacy and safety of the patients of myelodysplastic syndromes-refractory anemia with excess blasts (MDS-REAB)treated with decitabine alone or based on low dose cytarabine (Ara-C) regimen CAG/HAG [aclarubrci (ACR) / homoharring- tonine (HHT)+cytarabine+granulocyte colony stimulating factor (G-CSF) ]. Methods Totally 121 patients with MDS-REAB were retrospectively analyzed, including 59 patients treated with decitabine alone (20 mg·m^-2. d^-1 for 5 days), the rest 62 ones treated with low-dose Ara-C-based regimen CAG/HAG. Overall response rate (ORR), overall survival (OS) and adverse events of the two groups were analyzed and compared retrospectively. Results The ORR of decitabine alone or CAG/HAG were 66.2% and 56.4% respectively, with no statistically significant differences (x^2=1.185, P=0.276). Initial response rate detected by the end of first cycle of CAG/HAG was higher than that of decitabine alone (94.3% vs 69.2% ), there was statistically significant difference in t
ISSN:0253-2727
DOI:10.3760/cma.j.issn.0253-2727.2017.07.004