[1]崔巍,金正明,曹晶,等.地西他滨联合HAAG方案治疗进展期急性髓系白血病疗效分析[J].第三军医大学学报,2016,38(12):1379-1384.
 Cui Wei,Jin Zhengming,Cao Jing,et al.Decitabine combined with HAAG regimen is an effective salvage treatment for advanced acute myeloid leukemia[J].J Third Mil Med Univ,2016,38(12):1379-1384.
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《第三军医大学学报》[ISSN:1000-5404/CN:51-1095/R]

卷:
38卷
期数:
2016年第12期
页码:
1379-1384
栏目:
专题报道
出版日期:
2016-06-30

文章信息/Info

Title:
Decitabine combined with HAAG regimen is an effective salvage treatment for advanced acute myeloid leukemia
作者:
崔巍金正明曹晶朱霞明孙爱宁仇惠英苗瞄郭丹丹吴德沛唐晓文
苏州大学附属第一医院江苏省血液研究所,卫生部血栓与止血重点实验室,血液学协同创新中心
Author(s):
Cui Wei Jin Zhengming Cao Jing Zhu Xiaming Sun Aining Qiu Huiying Miao Miao Guo Dandan Wu Depei Tang Xiaowen

Collaborative Innovation Center of Hematology, Key Laboratory of Thrombosis and Hemostasis of Ministry of Health, Jiangsu Institute of Hematology, the First Affiliated Hospital of Soochow University, Suzhou, Jiangsu Province, 215006, China

关键词:
预激方案地西他滨HAAG急性髓系白血病
Keywords:
induction chemotherapydecitabine HAAG regimen acute myeloid leukemia
分类号:
R730.53; R733.71; R979.1
文献标志码:
A
摘要:

目的      探讨采用地西他滨(decitabine/dacogen, DAC)联合HAAG[三尖杉酯碱(HHT)、阿糖胞苷(Ara-C)、柔比星(Acla)与重组人粒细胞集落刺激因子(G-CSF)]治疗进展期急性髓系白血病(acute myeloid leukemia,AML)患者,观察其有效率及治疗相关毒性。      方法      分析我中心2012年12月至2015年8月收治的36例进展期AML患者,其中18例患者为标准难治复发患者,另外18例为一疗程标准诱导未缓解患者。36例患者均给予DAC联合HAAG方案再诱导化疗,观察其一疗程缓解率、化疗毒性及长期生存情况。      结果      36例患者一疗程完全缓解(complete remission, CR)率为58.3%(21/36),部分缓解(partial remission,PR)率为22.2%(8/36),总体有效率(overall response rate, ORR)为80.6%(29/36)。18例难治复发患者CR率为61.0%(11/18),PR率为22.2%(4/18),ORR为83.3%(15/18);18例一疗程标准诱导未缓解患者CR率为55.6%(10/18),PR率为22.2%(4/18),ORR为77.8%(14/18)。化疗相关血液学毒性均为4级,感染发生率为72.2%,大多数患者不良反应轻微可控。所有患者中位随访时间为7.5(0.5~33.3)个月,全部患者1年总生存(overall survival, OS)率为43.3%,难治复发患者1年OS率为24.2%,一疗程未缓解患者1年OS率为61.6%(P=0.01)。      结论      对于进展期AML患者,DAC+HAAG方案一疗程再诱导治疗反应率高,不良反应少。

Abstract:

Objective      To evaluate the clinical efficacy and safety of decitabine (DAC) in combination with HAAG regimen [homoharringtonine (HHT), cytarabine (Ara-C), doxorubicin (Acla) and recombinant human granulocyte colony stimulating factor (G-CSF)] for advanced patients with acute myeloid leukemia (AML).       Methods      Thirty-six patients with advanced AML receiving DAC combined with HAAG chemotherapy in our institute from December 2012 to August 2015 were enrolled in this study. Eighteen of them were refractory or relapsed AML, and another 18 patients were those who didn’t achieve complete remission (CR) after a course of induction chemotherapy. The therapeutic responses, side effects and long-time survival were retrospectively analyzed.       Results      After a course of treatment, the rate of CR and partial response (PR) was 58.3% (21/36) and 22.2%(8/36)respectively, while the overall response rate (ORR) was 80.6% (29/36) in the cohort. For the patients with refractory or relapse AML, CR was 61.0%(11/18), PR was 22.2% (4/18), and ORR was 83.3% (15/18). While for the other not getting CR after a course of induction chemotherapy, CR was 55.6%(10/18), PR was 22.2% (4/18), and ORR was 77.8% (14/18). Grade 4 hematological toxicities were observed in all patients, and 72.2% cases experienced infection. And all side effects were mild and well-tolerated. In the end of median 7.5 (0.5~33.3) months’ follow-up, the 1-year overall survival (OS) rate was 43.3%, 24.2% for the refractory or relapsed AML patients, and 61.6% for those not achieving CR after a course of induction chemotherapy, with significant differences (P=0.01).       Conclusion      DAC combined with HAAG regimen is safe and effective for advanced AML patients with less side effects.

参考文献/References:

[1]Yamada K, Furusawa S, Saito K, et al. Concurrent use of granulocyte colony-stimulating factor with low-dose cytosine arabinoside and aclarubicin for previously treated acute myelogenous leukemia: a pilot study[J]. Leukemia, 1995, 9(1): 10-14.
[2]张之南, 沈悌.血液病诊断及疗效标准[M].3版. 北京: 科学出版社, 2007: 131-134.
[3]中华医学会血液学分会.急性髓系白血病(复发难治性)中国诊疗指南(2011年版)[J].中华血液学杂志, 2011, 32(12): 887-888. DOI: 10.3760/cma.j.issn.0253-2727.2011.12.023
[4]Liu L, Qu Q, Jiao W, et al.Increasing aclarubicin dose in low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor(CAG regimen) is efficacious as salvage chemotherapy for relapsed/refractory mixed-phenotype acute leukemia[J].Leuk Res, 2015, 39(8): 805-811. DOI: 10.1016/j.leukres, 2015.04.006
[5]Xue S L, Cui H X, Zou J Y, et al. Low-dose cytarabine and aclarubicin combined with granulocyte colony-stimulating factor for the treatment of relapsed or primary refractory acute lymphocytic leukemia: a retrospective study of 25 Chinese patients[J].HematolOncol, 2013, 31(4): 206-212. DOI: 10.1002/hon.2051
[6]Qu Q, Liu L, Zhang Y, et al.Increasing aclarubicin dosage of the conventional CAG (low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor) regimen is more efficacious as a salvage therapy than CAG for relapsed/refractory acute myeloid leukemia[J].Leuk Res, 2015, 39(12): 1353-1359. DOI: 10.1016/j.leukres, 2015.09.014
[7]Horinaka M, Yoshida T, Nakata S, et al. Aclarubicin enhances tumor necrosis factor-related apoptosis-inducing ligand-induced apoptosis through death receptor 5 upregulation[J].Cancer Sci, 2012, 103(2): 282-287. DOI: 10.1111/j.1349-7006.2011.02150.x
[8]Lu S, Wang J.Homoharringtonine and omacetaxine for myeloid hematological malignancies[J].J HematolOncol, 2014, 7: 2. DOI: 10.1186/1756-8722-7-2
[9]周华, 唐晓文.去甲基化药物在异基因造血干细胞移植中的临床应用进展[J].中华临床医师杂志: 电子版, 2013, 7(24): 11755-11758. DOI: 10.3877/cma.j.issn.1674-0785.2013.24.159
[10]Chowdhury S, Seropian S, Marks P W.Decitabine combined with fractionated gemtuzumabozogamicin therapy in patients with relapsed or refractory acute myeloid leukemia[J]. Am J Hematol, 2009, 84(9): 599-600.DOI: 10.1002/ajh.21478
[11]高然, 张蕊, 于锦香, 等. 地西他滨联合半量CAG方案治疗老年性及复发难治性急性髓细胞白血病的疗效分析[J]. 中国医科大学学报, 2013, 42(6): 515-517. DOI: 10.3969/j.issn.0258-4646.2013.06.009
[12]Qin T, Youssef E M, Jelinek J, et al. Effect of cytarabine and decitabine in combination in human leukemic cell lines[J].Clin Cancer Res, 2007, 13(14): 4225-4232.DOI: 10.1158/1078-0432.CCR-06-2762
[13]Song LX, Xu L, Li X, et al.Clinical outcome of treatment with a combined regimen of decitabine and aclacinomycin/cytarabine for patients with refractory acute myeloid leukemia[J].Ann Hematol, 2012, 91(12): 1879-1886. DOI: 10.1007/s00277-012-1550-y
[14]Kantarjian H M, Thomas X G, Dmoszynska A, et al.Multicenter, randomized, open-label, phase Ⅲ trial of decitabineversus patient choice, with physician advice, of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia[J].J ClinOncol, 2012, 30(21): 2670-2677. DOI: 10.1200/JCO.2011.38.9429

更新日期/Last Update: 2016-06-07