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目的探讨预激方案治疗低增生性及复发与难治的急性髓系白血病(AML)的临床疗效。方法选择2005年1月至2011年1月在江苏省沭阳仁慈医院住院的低增生性及复发与难治的AML患者36例,采用CAG方案化疗,重组人粒细胞集落刺激因子(C-GSF)150~300μg/(m2?d),皮下注射,在化疗前12 h应用,第1~14天,皮下注射阿糖胞苷(Ara-c)15 mg、q 12 h,第1~14天,静脉滴注阿克拉霉素(AcLa)10 mg/d,静滴,第1~8天,对完全缓解(CR)后可选择不同的标准化疗方案交替巩固维持化疗,第1年每月1次,第二年每2月1次,第三年每3月次,对CR患者,常规使用甲氨喋呤预防中枢神经系统白血病。结果 CAG预激方案治疗总有效率75%(完全缓解50%,部分缓解25%)。病人的骨髓抑制期,即粒细胞缺乏和血小板重度减少的时间较短,重症感染发生率相对较低,消化道反应较轻。结论预激方案治疗低增生性及复发与难治的AML疗效肯定,副反应小,无病生存期延长,病人经济负担小。
Objective To investigate the clinical effect of pre-shock regimen in the treatment of patients with low proliferative, relapsed and refractory acute myeloid leukemia (AML). Methods Thirty-six patients with low proliferative, relapsed and refractory AML hospitalized in Jiangsu Shuyang Renzi Hospital from January 2005 to January 2011 were enrolled in this study. CAG regimen chemotherapy, recombinant human granulocyte colony stimulating factor (C-GSF) 150 ~ 300μg / (m2? D), subcutaneously, 12 hours before chemotherapy, on day 1 to 14, subcutaneous injection of Ara-c 15 mg, q 12 h, Intravenous infusion of Aclacacin (AcLa) 10 mg / d, intravenous drip, the 1st to 8 days, after complete remission (CR) can choose different standard chemotherapy alternative chemotherapy to maintain consolidation, 1 year once a month , The second year every 1 month, the third year every 3 months, CR patients, routine use of methotrexate to prevent central nervous system leukemia. Results The total effective rate of CAG shock therapy was 75% (complete remission 50%, partial remission 25%). Patients with myelosuppression, ie, agranulocytosis and severe reduction of platelet time is shorter, the incidence of severe infections is relatively low, less gastrointestinal reactions. Conclusions The treatment of AML with low proliferative, relapsed and refractory AML is positive. The adverse reaction is small, disease-free survival is prolonged, and patient’s economic burden is small.