上海交通大学学报（医学版）

›› 2009, Vol. 29 ›› Issue (11): 1355-.

• 论著（临床研究） • 上一篇    下一篇

CAG方案治疗AML和高危MDS患者的疗效及生存分析

倪蓓文, 陈芳源, 韩洁英, 钟 华, 钟 璐, 黄洪晖, 沈莉菁, 肖 菲   

  1. 上海交通大学 医学院仁济医院 血液科, 上海 200001
  • 出版日期:2009-11-25 发布日期:2009-11-24
  • 通讯作者: 陈芳源, 电子信箱: chenfy04@yahoo.com.cn。
  • 作者简介:倪蓓文（1979—）, 女, 住院医师, 硕士生；电子信箱: ninibei1@yahoo.com.cn。

Outcomes and survival analysis of patients with AML and high risk MDS treated by CAG regimen

NI Bei-wen, CHEN Fang-yuan, HAN Jie-ying, ZHONG Hua, ZHONG Lu, HUANG Hong-hui, SHEN Li-jing, XIAO Fei   

  1. Department of Hematology, Renji Hospital, School of Medicine, Shanghai Jiaotong University, Shanghai 200001, China
  • Online:2009-11-25 Published:2009-11-24

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摘要：

目的 评价CAG方案对初治、难治、复发性急性髓系白血病（AML）和高危骨髓增生异常综合征（MDS）患者的临床疗效和不良反应，分析影响患者长期生存的相关因素。方法 对61例AML患者（其中初治27例，复发16例，难治18例）和9例高危MDS患者实施CAG方案诱导缓解治疗。治疗前后进行心电图，肝、肾功能和骨髓检查，观察CAG方案的不良反应。根据患者的临床表现、外周血和骨髓细胞学检查结果评价近期疗效；随访分析患者总体生存期（OS）和无病生存期（DFS），评判CAG方案的长期疗效。运用生存曲线的Log-rank检验分析影响患者长期生存的因素。结果 CAG方案治疗一个疗程的总有效率为71%，其中34例（49%）达到完全缓解。本组中位随访时间45个月，中位OS为28个月，中位DFS为23个月。年龄、初发时乳酸脱氢酶（LDH）水平、CAG方案治疗一个疗程是否达缓解或是否采用HD-Ara-C作为巩固治疗方案均是患者OS和DFS的影响因素。临床不良反应主要为骨髓抑制，其中粒细胞缺乏（中性粒细胞<0.5×109/L）的中位持续时间为13 d，血小板减少（血小板<20×109/L）中位持续时间9 d。结论 采用CAG方案治疗初治、难治、复发AML和高危MDS患者，不良反应轻，远期疗效较好。发病年龄、发病时LDH水平、是否一个疗程缓解及是否予以HD-Ara-C作为巩固治疗方案是影响患者生存期的主要因素。

关键词: CAG方案, 骨髓增生异常综合征, 急性髓系白血病, 疗效

Abstract:

Objective To evaluate the clinical efficacy and adverse effects of CAG regimen in treatment of primary, refractory and relapsed acute myeloid leukemia (AML) and high risk myelodysplastic syndrome (MDS), and analyse the factors influencing long-term survival. Methods Sixty-one patients with AML (primary, n=27; refractory, n=18; relapsed, n=16) and 9 patients with MDS were treated with CAG regimen. Examinations on liver and renal function, electrocardiogram and bone marrow cytology were performed before and after treatment, and adverse effects of CAG were observed. Short-term efficacy was evaluated based on clinical manifestation, peripheral blood and bone marrow cytologic examinations. Patients were followed up, overall survival (OS) and disease free survival (DFS) were analysed, and long-term efficacy of CAG regimen was evaluated. The factors influencing long-term survival were analysed by Log-rank test of survival curve. Results After a course of treatment by CAG regimen, the total effective rate was 71%, and 34 patients (49%) experienced complete remission. The median time of follow-up was 45 months, the median OS was 28 months, and the median DFS was 23 months. Age, level of lactate dehydrogenase (LDH), remission condition after a course of treatment by CAG regimen and adoption of HD-Ara-C regimen as consolidation treatment were influencing factors for OS and DFS. The dominant clinical adverse effects were bone marrow depression, with 13 d as the median duration of agranulocytosis (neutrophil <0.5×109/L) and 9 d as the median duration of thrombocytopenia (platelet<20×109/L). Conclusion CAG regimen may lead to favourable therapeutic effects in treatment of primary, refractory and relapsed AML and high risk MDS, and may yield less adverse effects and better long-term therapeutic effects. Age, level of LDH, remission condition after a course of treatment and adoption of HD-Ara-C regimen as consolidation treatment are dominant influencing factors for survival.

Key words: CAG regimen, myelodysplastic syndrome, acute myeloid leukemia, effect