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目的探讨国产地西他滨联合减量[粒细胞集落刺激因子(G-CSF)+吡柔比星(THP)+阿糖胞苷(Ara-C)](CTG方案)治疗中高危骨髓增生异常综合征(MDS)和急性髓细胞白血病(AML)的疗效、安全性和影响疗效的相关因素。方法收集2014年5月至2015年6月东莞市人民医院血液科收治的21例中高危MDS和AML患者的临床资料,应用国产地西他滨联合减量CTG方案治疗。结果21例患者中,完全缓解者7例,PR者8例,治疗失败者6例,总有效率为71.4%。1例死亡(4.8%)。所有患者在治疗过程中均出现不同程度的骨髓抑制,第1、2个疗程的粒缺持续时间、Ⅳ度血小板减少持续时间差异无统计学意义(P>0.05),感染的发生率差异也无统计学意义(P>0.05),高龄患者骨髓抑制时间更长,不良反应更严重,所有患者非血液学不良反应均可耐受。单因素分析结果显示,自发病至接受去甲基化药物治疗时间低于半年者、第1个疗程后血小板计数较基础值提高的患者,疗效较好,预后基因FLT3阳性患者疗效不佳。患者的年龄、性别和是否存在染色体核型异常与疗效无显著相关性。结论国产地西他滨联合减量CTG方案可有效地治疗MDS和AML,能够降低肿瘤负荷,抑制不良反应,主要不良反应为骨髓抑制和感染。
Objective To investigate the efficacy and safety of decitabine combined with G-CSF plus THP and Ara-C (CTG regimen) in treating middle-high risk myelodysplastic syndrome Syndrome (MDS) and acute myeloid leukemia (AML) efficacy, safety and related factors affecting the efficacy. Methods The clinical data of 21 patients with moderate-high risk MDS and AML admitted to Department of Hematology, Dongguan People’s Hospital from May 2014 to June 2015 were collected and treated with decitabine plus CTG regimen. Results Of the 21 patients, 7 were completely relieved, 8 were PR, and 6 were failed. The total effective rate was 71.4%. One patient died (4.8%). All patients showed different degrees of myelosuppression during the course of treatment. There was no significant difference in the duration of the first and second courses of laryngeal granuloma, and the duration of Ⅳth thrombocytopenia (P> 0.05). There was also no difference in the incidence of infection Statistical significance (P> 0.05), elderly patients with longer bone marrow suppression, more serious adverse reactions, all patients can be tolerated non-hematological adverse reactions. Univariate analysis showed that patients with FLT3-positive patients with poor prognosis were less likely to have FLT3-positive patients after the first course of treatment with patients whose hypothyroidism was less than six months after the onset of treatment and patients with elevated platelet counts after the first course of treatment. There was no significant correlation between the patient’s age, sex and the existence of chromosomal abnormalities. Conclusion The decitabine combined with CTG regimen can effectively treat MDS and AML, which can reduce tumor burden and inhibit adverse reactions. The main adverse reactions are myelosuppression and infection.