Hao Jie, Wang Li, Wang Yanyu, Liu Zhenyu, Gu Xiao, Liu Jiaqi, Li Liangqun, Duan Yunyi, Chen Yu, Zhao Weili, Shen Zhixiang
Department of Hematology, Shanghai Jiao-Tong University Affiliated Ruijin Hospital, Shanghai 200025, China.
Zhonghua Xue Ye Xue Za Zhi. 2014 Jun;35(6):481-5. doi: 10.3760/cma.j.issn.0253-2727.2014.06.001.
To compare the clinical efficacy and safety among different chemotherapeutic regimens in treatment of refractory/relapsed acute myeloid leukemia (AML).
The clinical data of 67 refractory/relapsed AML patients enrolled from September 2008 to April 2013 were collected. The differences of clinical outcome and adverse events among the patients treated with decitabine combined with DAG regimen, CAG regimen or "3+7" regimen were analyzed.
Among 19 patients in decitabine treatment group, 5 (26.3%) achieved complete remission (CR), 4 (21.1%) partial remission (PR), with overall response rate (ORR) of 47.4 %. Of 26 patients in CAG regimen group, 8 (30.8%) achieved CR, 1 (3.8%) PR, with ORR of 34.6%. Of 22 patients in "3+7" regimen group, 4 (18.2%) achieved CR, with ORR of 18.2%. The ORR of decitabine group was significantly higher than that of "3+7" group (P<0.05). However, no significant difference of ORR was observed among the three groups (P>0.05). It was interesting to note that in decitabine group, the marrow blast counts were lower in CR patients compared with those in non-CR patients (P<0.05), while this was not found in "3+7" group (P>0.05) and CAG regimen group (P>0.05). Adverse events in the three groups were similar, mainly including myelosuppression, pulmonary infection, nausea, vomiting and liver dysfunction, and could be well tolerated. Followed- up to September 2013, the median overall survival (OS) of decitabine group, CAG regimen group and "3+7" group after relapse was 7.5, 4 and 3 months, respectively (P>0.05), while significant difference was obtained between decitabine group and "3+7" regimen group (P<0.05).
Decitabine combined with DAG regimen is effective and well tolerated in refractory/relapsed AML patients who were unsuitable for intensive chemotherapy and hematopoietic stem cell transplantation, and the patients with low marrow blast counts are more suitable for the application of decitabine combined with DAG regimen.
比较不同化疗方案治疗难治性/复发性急性髓系白血病（AML）的临床疗效及安全性。
收集2008年9月至2013年4月收治的67例难治性/复发性AML患者的临床资料，分析地西他滨联合DAG方案、CAG方案或“3+7”方案治疗患者的临床疗效及不良事件差异。
地西他滨治疗组19例患者中，5例（26.3%）达到完全缓解（CR），4例（21.1%）部分缓解（PR），总缓解率（ORR）为47.4%。CAG方案组26例患者中，8例（30.8%）达到CR，1例（3.8%）PR，ORR为34.6%。“3+7”方案组22例患者中，4例（18.2%）达到CR，ORR为18.2%。地西他滨组ORR显著高于“3+7”组（P<0.05）。然而，三组间ORR差异无统计学意义（P>0.05）。有趣的是，地西他滨组CR患者的骨髓原始细胞计数低于未达到CR的患者（P<0.05），而“3+7”组（P>0.05）和CAG方案组（P>0.05）未发现此现象。三组不良事件相似，主要包括骨髓抑制、肺部感染、恶心、呕吐及肝功能损害，且耐受性良好。随访至2013年9月，地西他滨组、CAG方案组及“3+7”组复发后的中位总生存期（OS）分别为7.5个月、4个月和3个月（P>0.05），但地西他滨组与“3+7”方案组间差异有统计学意义（P<0.05）。
地西他滨联合DAG方案治疗不适合强化疗及造血干细胞移植的难治性/复发性AML患者有效且耐受性良好，骨髓原始细胞计数低的患者更适合应用地西他滨联合DAG方案。
