CAJ | 학술논문

目的探讨小剂量CHG预激方案[小剂量阿糖胞苷(Ara-C)、高三尖杉酯碱(HHT)联合粒细胞集落刺激因子(G-CSF)]对老年急性髓系白血病(AML)的治疗疗效和毒副作用.方法选择年龄＞60岁的AML初治患者共35例,采用CHG方案治疗:在化疗前12 h皮下注射粒细胞集落刺激因子(G-CSF)200μg/m2后,应用14d,HHT1 mg/m2,第1天至第14天,1次/d;Ara-C 10mg/m2,第1天至第14天,皮下注射,每12h 1次.治疗过程中,WBC＞20×109/L时暂停使用G-CSF,但不停化疗,待WBC回落后再继续使用.对完全缓解(CR)者后期可选择不同方案交替巩固化疗.结果第1个疗程后12例患者获得CR,15例获得部分缓解(PR),8例未缓解(NR).第2个疗程后,15例PR患者5例取得CR,8例NR患者有2例获得PR,总有效率83%(29/35).17例获得CR的患者中11例按计划巩固强化治疗未复发,生存期为12～34个月,中位生存18个月;6例复发,经过原方案诱导后1例CR、4例PR、1例NR.CHG方案血液学毒性低,非血液学毒性不明显.结论初治的老年AML患者采用小剂量CHG预激方案诱导缓解的疗效较好、不良反应可耐受.
목적 탐토소제량CHG예격방안[소제량아당포감(Ara-C)、고삼첨삼지감(HHT)연합립세포집락자격인자(G-CSF)]대노년급성수계백혈병(AML)적치료료효화독부작용.방법 선택년령＞60세적AML초치환자공35례,채용CHG방안치료:재화료전12 h피하주사립세포집락자격인자(G-CSF)200μg/m2후,응용14d,HHT1 mg/m2,제1천지제14천,1차/d;Ara-C 10mg/m2,제1천지제14천,피하주사,매12h 1차.치료과정중,WBC＞20×109/L시잠정사용G-CSF,단불정화료,대WBC회락후재계속사용.대완전완해(CR)자후기가선택불동방안교체공고화료.결과 제1개료정후12례환자획득CR,15례획득부분완해(PR),8례미완해(NR).제2개료정후,15례PR환자5례취득CR,8례NR환자유2례획득PR,총유효솔83%(29/35).17례획득CR적환자중11례안계화공고강화치료미복발,생존기위12～34개월,중위생존18개월;6례복발,경과원방안유도후1례CR、4례PR、1례NR.CHG방안혈액학독성저,비혈액학독성불명현.결론 초치적노년AML환자채용소제량CHG예격방안유도완해적료효교호、불량반응가내수.
Objective To explore the efficacy and side effect of inductive chemotherapy with lowdose,cytarabine,homoharringtonine and granulocyte colony-stimulating factor(CHG) in elderly acute myeloid leukemia(AML). Methods Thirty-five elderly patients (age＞60 years) with AML were enrolled for the initial treatment with CHG regimen,The CHG regimen consisted of cytarabine 10 mg/m2 per 12 h by subcutaneous injection,days 1-14,homoharringtonine 1 mg/m2 per day by intravenous continuous infusion,days 1-14,and G-CSF 200 μg/m2 per day by subcutaneous injection 12 h before chemotherapy,days 0-14. G-CSF only was used when white blood cell count(WBC) was less than 20×109/L during the whole course. Results After the first course,12 patients achieved complete response (CR),15 patients achieved partial response(PR),and 8 patients had no response(NR). After the second course,5 of 15 PR patients achieved CR,2 of 8 NR patients achieved PR. The total effective rate was 82 % (29/35). Of those 17 CR patients,eleven patients continued maintenance therapy and remained in remission for 12-34 months with a median CR duration of 18 months,the other 6 patients relapsed and were treated with original regimen,including one achieved CR again,4 achieved PR,and 1 achieved NR. The CHG regimen had mild hematologic toxicities and no severe nonhematologic toxicities. Conclusion CHG regimen is effective and well tolerated in remission for elderly AML.