不同挽救治疗方案对初始诱导失败和复发的急性髓系白血病患者的疗效比较

发布时间：2018-06-29 13:14

本文选题：挽救治疗方案 + MAC方案　；参考：《中国实验血液学杂志》2017年02期

【摘要】：目的:探讨MAC(米托蒽醌、阿糖胞苷、环磷酰胺)、FLAG(氟达拉滨、阿糖胞苷、粒系集落刺激因子)及CAG(阿糖胞苷、阿克拉霉素、粒系集落刺激因子)方案治疗初始诱导失败和复发的急性髓系白血病(AML)患者的疗效。方法:回顾性分析本中心2008年1月至2016年4月间经MAC、FLAG或CAG方案挽救治疗的初始诱导失败和复发的156例AML患者(除外急性早幼粒细胞白血病)的临床资料,按化疗方案分为156患者MAC组(60例)、FLAG组(45例)和CAG组(51例)。比较不同挽救方案的完全缓解率(CR)、部分缓解率(PR)、总生存(OS)、无病生存(DFS)以及治疗过程中的不良反应。结果:化疗后完全缓解率(CR),MAC组高于FLAG组和CAG组(55.4%vs 34.1%vs 34.0%)(P0.05)。MAC、FLAG和CAG组的中位生存期分别为11、5.46和10.2个月,3个组生存率无明显差异(P0.05)。骨髓抑制仍为主要的不良反应,3个组之间无统计学差异(P0.05)。经MAC方案治疗的患者更多地出现粒细胞缺乏性发热(93.3%vs 86.7%vs 64.7%)(P0.001);但致死性感染的发生率3组之间无统计学差异(5%vs 8.9%vs 5.9%)(P0.05)。结论:与FLAG及CAG方案相比,MAC方案可以使更多的初始诱导失败和复发的AML患者获得缓解,且没有增加严重不良事件的发生,从而为更多的患者提供了后续进行造血干细胞移植的机会。
[Abstract]:Objective: to investigate MAC (mitoxantrone, cytarabine, cyclophosphamide) FLAG (fludarabine, cytarabine, granulocyte colony-stimulating factor) and CAG (cytarabine, aclacinomycin). Effect of granulocyte colony-stimulating factor (GCSF) regimen on acute myeloid leukemia (AML) patients with initial induction failure and relapse. Methods: the clinical data of 156 AML patients (excluding acute promyelocytic leukemia) who were treated with MACG-FLAG or CAG regimen from January 2008 to April 2016 were retrospectively analyzed. According to chemotherapy regimen, 156 patients were divided into MAC group (60 cases), FLAG group (45 cases) and CAG group (51 cases). The complete remission rate (CR), partial remission rate (PR), total survival (OS), disease-free survival (DFS) and adverse reactions during the treatment were compared. Results: the complete remission rate (CR) in the MAC group was higher than that in the FLAG group and the CAG group (34.0%) (P0.05). The median survival time of MACG-FLAG and CAG group was 115.46 and 10.2 months, respectively. There was no significant difference in survival rate among the three groups (P0.05). Bone marrow suppression is still the main adverse reaction, there is no statistical difference among the three groups (P0.05). Granulocytic fever (93.3%vs 86.7%vs 64.7%) was more common in patients treated with 93.3%vs 86.7%vs regimen (P0. 001), but there was no significant difference in the incidence of fatal infection among the three groups (5%vs 8.9%vs 5. 9%) (P0.05). Conclusion: compared with the FLAG and CAG protocols, the MAC regimen can relieve more AML patients with initial induction failure and relapse, and does not increase the incidence of severe adverse events. This will provide more patients with follow-up hematopoietic stem cell transplantation opportunities.
【作者单位】：中国医学科学院北京协和医学院血液病医院血液学研究所;
【基金】：天津市科技支撑计划重点项目(13ZCZDSY02200)
【分类号】：R733.71

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