ObjectiveTo analyze the clinical efficacy of decitabine contained chemotherapy regimens in the treatment of relapsed or refractory acute myeloid leukemia (AML) patients.MethodsA total of 101 patients with relapsed or refractory AML from May 2014 to December 2017 were collected retrospectively. Three schemes with a relatively larger number of users were included: 15 cases were treated with decitabine monotherapy (DAC regime); 37 cases were treated with decitabine, anthracycline antibiotic, and cytarabine (D-DA regime); and 49 cases were treated with decitabine, cytarabine, aclarubicin, and granulocyte colony-stimulatingfactor (G-CSF) (D-CAG regimen). The remission rate, blood products support strength, degree and duration of bone marrow suppression, adverse reaction, and survival time were compared.ResultsThe complete remission (CR) rates of DAC, D-DA and D-CAG regimen group were 40.0%, 48.6%, and 71.4%, respectively; the overall respond rates (ORR) were 46.7%, 54.1%, and 79.6%, respectively. The ORR in D-CAG regimen group was higher than those in the other two groups (P<0.017). The dosage of G-CSF in D-CAG regimen group were lower than those in DAC regimen group [ (1 363.0±1 037.9) vs. (2 517.0±1 163.4) μg, P<0.05]; the mean number of erythrocyte transfusion and the dosage of G-CSF were lower than those in D-DA regimen group [(6.7±4.0) vs. (14.8±10.1) U, P<0.05; (1 363.0±1 037.9) vs. (2 786.0±1474.0) μg, P<0.05]; the time to the suppression of hemoglobin and platelet in D-CAG regimen group were later than those in D-DA regimen group [(11.5±2.6) vs. (8.8±2.5) days, P=0.007; (10.9±2.6) vs. (7.6±2.5) days, P=0.002]; the time to the suppression of platelet was later than that in DAC regimen group [(10.9±2.6) vs. (7.6±1.6) days, P=0.003]. There was no statistically significant difference in the incidence of adverse reations among the three group (P>0.05). The median overall survival of D-CAG regimen group was longer than that in DAC regimen group (11.6 vs. 8.8 months, P=0.013).ConclusionAmong the three chemotherapy regimens containing decitabine, the CR and ORR of D-CAG regimen are higher, the tolerance is better, and further promotion can be attempted in qualified medical institutions.
目的 探讨骨髓增生异常综合征（MDS）患者的临床特点。 方法 选取我院2008年3月－2012年10月确诊为MDS的231例患者临床资料进行回顾性分析。患者年龄21～87岁，中位年龄59岁。 结果 231例患者中，难治性血细胞减少伴多系发育异常（RCMD）最多见，占45.0%（104/231）；以贫血乏力症状就诊多见占66.7%（154/231）；血常规中以全血细胞均减少多见占61%（141例/231例）；网织红细胞以正常或增高为主占61%（141/231）；低荧光值增高多见62%（144/231）。乳酸脱氢酶和铁蛋白在各诊断亚型及各国际预后积分系统（IPSS）评分间存在差异，其中乳酸脱氢酶在难治性贫血伴原始细胞增多2型（RAEB-2）中高于综合组：难治性贫血（RA）、 难治性贫血伴环状铁粒幼细胞（RAS）、5q?综合征及RCMD相比较差异有统计学意义（P＜0.05），高危组乳酸脱氢酶高于中危1组及中危2组，其差异有统计学意义（P＜0.05），高危组铁蛋白高于中危1组其差异有统计学意义（P＜0.05），其余差异无统计学意义（P＞0.05）。染色体异常率为39%，其中20例为复杂染色体核型，IPSS评分中危1最多见为52.4%（55/105）。 结论 MDS临床表现多样，缺乏特异性，需综合骨髓涂片、活检、细胞遗传学的结果提高诊断率。