阿扎胞苷对中高危骨髓增生异常综合征的临床疗效观察-东南大学学报医学版

阿扎胞苷对中高危骨髓增生异常综合征的临床疗效观察

单位：蚌埠市第三人民医院血液内科, 安徽蚌埠 233000

分类号：R733.3

出版年·卷·期（页码）：2020·39·第二期（193-196）

摘要：

目的：比较单纯应用去甲基药物阿扎胞苷（AZA）和阿糖胞苷（Ara-c）加阿克拉霉素（ACR）加粒细胞集落刺激因子（G-CSF）的CAG方案联合地西他滨对中高危骨髓增生异常综合征（MDS）的疗效和安全性。方法：回顾性分析我院50例中高危MDS患者的临床资料，其中20例患者采用CAG联合地西他滨方案，30例患者单用AZA，比较治疗4个疗程后两组患者对治疗的反应率及不良反应发生率的差异。结果：治疗4个疗程后，CAG联合地西他滨方案组治疗的总有效率（ORR）为64.7%，包括完全缓解（CR）3例、部分缓解（PR）3例、血液学改善（HI）6例，AZA组ORR为66.7%，包括CR 5例、PR 13例、HI 2例，两组ORR差异无统计学意义（P>0.05），但缓解（PR+CR）率差异具有统计学意义（P＝0.04）。不良反应方面，AZA组较CAG联合地西他滨方案组Ⅲ~Ⅳ级血红蛋白减少、Ⅲ~Ⅳ级血小板减少、Ⅲ~Ⅳ级中性粒细胞绝对值减少的发生率均显著降低，两组间感染的发生率差异无统计学意义。结论：AZA治疗高危MDS较CAG联合地西他滨方案缓解率显著提高，不良反应显著减少，值得在不能进行骨髓造血干细胞移植的中高危MDS患者中推广。

Objective: To compare the efficacy and safety of demethylated drug azacitidine(AZA) with those of CAG, which consisted of cytarabine arabinoside(ara-c), acramycin(ACR) and granulocyte colony-stimulating factor(G-CSF), combined with descitabine in the treatment of patients with middle and high risk myelodysplastic syndrome(MDS). Methods: Clinical data of 50 MDS cases were retrospectively analyzed, of whom 20 cases were treated with CAG combined with descitabine and 30 received azacitidine treatment alone. The response rate and the incidence of adverse reactions between the two groups after 4 courses of treatment were compared. Results: After 4 courses of treatment, the overall response rate(ORR) of the group CAG combined with descitabine was 64.7%, including 3 complete response(CR), 3 partial response(PR) and 6 hematological improvement(HI), while the ORR in azacytarine group was 66.7%,including 5 CR, 13 PR and 2 HI. There was no statistically significant difference in ORR between the two groups(P>0.05), but there was statistically significant difference in the response rate of CR and PR(P=0.04). In terms of adverse reactions, compared to the group CAG combined with descitabine,the incidence of Ⅲ-Ⅳ level decrease in hemoglobin, platelet count and absolute neutrophil count in azacytarine group were lower. There were no statistically significant differences in the incidence of infection between the two groups. Conclusion: Compared with CAG combined with descitabine, AZA can significantly increase the remission rate and reduce the occurrence of adverse reactions in the treatment of patients with middle and high risk MDS. Therefore, it is worthy to be promoted in MDS patients who are not feasible to undergo bone marrow hematopoietic stem cell transplantation.

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