小剂量高三尖杉酯碱、阿糖胞苷联合G-CSF治疗急性髓细胞白血病28例临床分析
Low dose of homoharringtonine and cytarabine combined with G-CSF for treatment of acute myelocytic leukemia: report of 28 cases
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摘要: 目的:探讨小剂量高三尖杉酯碱(HHT)、阿糖胞苷(Ara-c)联合粒细胞集落刺激因子(G-CSF)即HAG方案治疗急性髓细胞白血病(acute myelocytic leukemia,AML)的疗效。方法:28例AML中M1 3例,M2a 10例,M2b 1例,M4 2例,M5 8例,骨髓增生异常综合征(MDS)4例,均行HAG方案治疗。HHT 1 mg/d及Ara-c 25~50 mg/d静脉滴注第1~14天,G-CSF 150~300μg/d皮下注射,如WBC>20×109/L,则暂停用G-CSF,待WBC回落后继续使用。结果:AML达完全缓解15例,其中4例采用米妥蒽醌+阿糖胞苷、吡柔比星+阿糖胞苷化疗1~2疗程未缓解者,有效率(部分缓解+完全缓解)为78%(22/28)。28例中有10例≥ 60岁,完全缓解7例,化疗不良反应轻。结论:HAG方案对AML的疗效明显,且对老年性、继发性或耐药性白血病效果肯定。Abstract: Objective: To explore the clinical effect of low dose of homoharringtonine(HHT) and cytarabine(Ara-c) combined with granulocyte colony-stimulating factor(G-CSF) (HAG regimen) in treating acute myelocytic leukemia(AML).Methods: Twenty-eight patients with AML including 3 cases of M1,10 cases of M2a,1 case of M2b,2 cases of M4,8 cases of M5 and 4 cases of myelodysplas-ticsyndrome(MDS) were treated with HAG regimen.HHT 1 mg/d intravenous infusion and Ara-c 25-50 mg/d intravenous infusion were administered from 1st to 14th day;G-CSF 150-300 μg/d was injected subcutaneously.If the white blood cell count rose to 20×109/L,G-CSF was suspended until the WBC dropped to normal.Results: Complete remission(CR) and partial remission(PR) were observed in 22 of the total 28 cases(78%).Among the 15 CR cases,4 had received mitoxantrone and cytarabine,pirarubicin and cytarabine regimen for two cycles before but had achieved no remission.Ten of the 28 cases were elderly AML(≥ 60 years),and CR was noted in 7 of them.Conclusions: The regimen of low dose of homoharringtonine and cytarabine in combination with G-CSF is effective for patients with relapsed and/or secondary acute myeloid leukaemia,especially the elderly.