【摘要】：目的探討超小劑量地西他濱方案治療骨髓增生異常綜合征(MDS)的臨床療效及安全性。方法收集2014年1月至2015年10月江蘇省人民醫(yī)院血液科收治接受地西他濱治療可評價的MDS患者37例。皮下注射地西他濱(每日5~7 mg/m2,治療第1~3天,第8、15、22天),每4周為1個療程,連續(xù)4~6個療程。比較不同預(yù)后分組間療效差異,評價可能與療效相關(guān)的參數(shù)。結(jié)果 20例(54%)獲得了臨床反應(yīng),其中2例(5.4%)完全緩解,骨髓完全緩解無血液學(xué)改善1例(2.7%),骨髓完全緩解伴血液學(xué)改善1例(2.7%),血液學(xué)改善14例(37.8%),脫離輸血2例(5.4%);疾病穩(wěn)定14例(37.8%),疾病進(jìn)展3例(8.1%)。按WPSS預(yù)后分層分組,較低危組與較高危組之間總反應(yīng)率差異有統(tǒng)計學(xué)意義(70.0%對35.3%,χ~2=4.457,P=0.035);按IPSS-R細(xì)胞遺傳學(xué)分層,預(yù)后良好組與中危組、高危組之間總反應(yīng)率差異有統(tǒng)計學(xué)意義(60%對25%,χ~2=6.036,P=0.014);根據(jù)查爾森合并癥指數(shù)(CCI)分組,各組間療效差異無統(tǒng)計學(xué)意義。Ⅲ~Ⅳ度骨髓抑制13例(35.1%);在粒細(xì)胞缺乏期9例(24.3%)(Ⅱ~Ⅳ度)發(fā)生感染性發(fā)熱;沒有因血液學(xué)毒性而死亡;未觀察到Ⅲ~Ⅳ級胃腸道及心、肝、腎等毒副反應(yīng)。骨髓抑制、發(fā)熱等不良反應(yīng)根據(jù)CCI危險分層比較,低危、中危及高危之間不良反應(yīng)發(fā)生率差異無統(tǒng)計學(xué)意義(P0.05)。結(jié)論超小劑量地西他濱方案治療MDS療效佳,且耐受性良好,低、中危組MDS療效好于高危組。有合并癥不影響療效。
[Abstract]:Objective to evaluate the efficacy and safety of low dose dietabine regimen in the treatment of myelodysplastic syndrome (MDS). Methods from January 2014 to October 2015, 37 patients with MDS treated with desitabine in hematology department of Jiangsu Provincial people's Hospital were collected. Dietabine was subcutaneously injected (5: 7 mg/m2, per day, day 1: 3, day 8, 15, 22), every 4 weeks as a course of treatment for 4 ~ 6 consecutive courses. To compare the difference of curative effect among groups with different prognosis, and to evaluate the parameters that may be related to curative effect. Results Clinical reactions were obtained in 20 cases (54%), of which 2 cases (5.4%) had complete remission. There was no hematological improvement in 1 case (2.7%), hematological improvement in 14 cases (37.8%), blood transfusion in 2 cases (5.4%), stable disease in 14 cases (37.8%), disease progression in 3 cases (8.1%). According to WPSS prognostic stratification, there was significant difference in the total response rate between the lower risk group and the higher risk group (70.0% vs 35.33%, 蠂 2 4.457 P0. 035), and according to the IPSS-R cytogenetic stratification, the prognosis was better in the group with good prognosis than that in the group of the middle risk group. There was significant difference in total response rate between high risk groups (60% vs 25%, 蠂 2 + 6.036% P0. 014). According to the Charlson complication index (CCI), there was no significant difference in the total response rate between the two groups. 13 cases (35.1%) of grade 鈪，

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