地西他滨联合CHG方案诱导化疗骨髓增生异常综合征转化急性髓系白血病疗效观察.docVIP

地西他滨联合CHG方案诱导化疗骨髓增生异常综合征转化急性髓系白血病疗效观察 　　摘要：目的 观察地西他滨联合CHG方案诱导化疗由骨髓增生异常综合征转化的急性髓系白血病的疗效和安全性。方法 7例新确诊post MDS-AML患者接受地西他滨联合CHG方案诱导化疗。结果 4例获完全缓解，1例达到部分缓解，总有效率约为71.42％（5/7）。4例患者出现Ⅳ度骨髓抑制，重度骨髓抑制发生率为57.14％（4/7）。5例并发感染，感染率71.42％（5/7），其中１例治疗无效死亡，化疗相关死亡率14.28％（1/7）。不良反应可见发热及胃肠道反应等。结论 地西他滨联合CHG的诱导方案对骨髓增生异常综合征转化的急性髓系白血病有效，且有效率高，严重骨髓抑制是常见并发症，不良反应可以耐受。 　　关键词：地西他滨；CHG；骨髓增生异常综合征转化急性髓系白血病 　　Curative Effect of Induction Chemotherapy for Patients with MDS-transformed Acute Myeloid Leukemia with Decitabine Combined with CHG Regimen 　　YI Xue,YU Dan,ZHANG Ting,ZOU Liang 　　(Wuhan Integrated Tcm and Western Medicine Hospital,Wuhan 430022,Hubei,China) 　　Abstract：ObjectiveTo evaluate the induction chemotherapy effect and safety of decitabine combined with CHG regime for MDS-transformed acute myeloid leukemia (post MDS-AML)．Methods7 patients with post MDS-AML were treated with decitabine combined with CHG regimen．Results4 patients achieved complete remission，１patient achieved partial remission，total effetive rate was 71.42%．4 patients achieved Ⅳ bone marrow depression and the incidence rate of grade Ⅳbone marrow depression was 57.14%(4/7).5 patients achieved infection,incidence rate of infection was 71.42％(5/7)，one of the two infected patients died，which the mortality rate of the treatment 14.28％(1/7)．Fever and sickness andwas observed as adverse effect of the regimen.Conclusion The induction chemotherapy of decitabine combined with CHG regime for MDS-transformed acute myeloid leukemia (post MDS-AML) works effectively．The incidence of IV grade bone marrow depression happened offen，and adverse effect were light． 　　Key words：Decitabine；CHG；MDS-transformed acute myeloid leukemia 　　MIC协作组的数据表明，MDS最终转化为AL的发生率约为21～30%，尤其是中高危组MDS。转化的AL预后较差，主要向髓系方向进展，其中M2、M4和M5常见，ALL可见。与原发性AL相比，继发性髓系白血病（post MDS-AML或post MDS-AML或MDS/AML）大多为低增生性，骨髓储备能力差，治疗效果差，缓解率低[1]。诱导化疗post MDS-AML一直首选联合化疗[2,3]，多种联合方案正在临床研究中，一线推荐方案尚无定论。目前，联合化疗治疗post MDS-AML的CR率只有26.1%，远低于原发AML，治疗相关并发症和死亡率均较高，此为临床治疗的难点。我科应用地西他滨联合CHG方案诱导化疗7例p