CAJ | 학술논문

目的观察丙戊酸(VPA)联合小剂量化疗治疗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2007年6月至2009年6月41例初治MDS患者,19例采用小剂量化疗,22例采用VPA联合小剂量化疗.小剂量化疗方案:中危组采用静脉滴注高三尖杉酯碱1～2mg/d,14～28 d;或皮下注射阿糖胞苷15 mg/m2,每12小时1次,14～21 d;或阿克拉霉素5～7 mg·m-2·d-1,1～8 d,15～23 d;中性粒细胞缺乏时,皮下注射粒细胞集落刺激因子(G-CSF)200μg·m-2·d-1.高危组采用以上化疗药物中任意两种组合化疗.结果 VPA组完全缓解(CR)9例(40.9%),总有效率为77.2%(17/22).对照组CR 6例(31.6%),总有效率为47.4%(9/19).VPA组总有效率高于对照组(P＜0.05),但CR率比较差异无统计学意义(P＞0.05).结论 VPA联合小剂量化疗治疗中高危MDS安全有效,长期疗效仍需进一步观察.
목적 관찰병무산(VPA)연합소제양화료치료중고위골수증생이상종합정(MDS)적료효화안전성.방법 회고성분석2007년6월지2009년6월41례초치MDS환자,19례채용소제양화료,22례채용VPA연합소제양화료.소제양화료방안:중위조채용정맥적주고삼첨삼지감1～2mg/d,14～28 d;혹피하주사아당포감15 mg/m2,매12소시1차,14～21 d;혹아극랍매소5～7 mg·m-2·d-1,1～8 d,15～23 d;중성립세포결핍시,피하주사립세포집락자격인자(G-CSF)200μg·m-2·d-1.고위조채용이상화료약물중임의량충조합화료.결과 VPA조완전완해(CR)9례(40.9%),총유효솔위77.2%(17/22).대조조CR 6례(31.6%),총유효솔위47.4%(9/19).VPA조총유효솔고우대조조(P＜0.05),단CR솔비교차이무통계학의의(P＞0.05).결론 VPA연합소제양화료치료중고위MDS안전유효,장기료효잉수진일보관찰.
Objective To evaluate the efficacy and adverse effect of valproic acid (VPA) in combination with low dose chemotherapy on intermediate and high-risk myelodysplastic syndrome. Methods A total of 41 patients with intermediate (34) and high-risk (7) myelodysplastic syndrome were retrospectively analyzed. Among them, 19 patients received low dose chemotherapy regimen and 22 received low dose chemotherapy plus VPA.Low dose chemotherapy regimen included: homoharringtonine,1-2 mg·m-2·d-1 intravenously,14-28 d; clarubicin,5-7 mg·m-2·-1 intravenously,1-8 d,15-23 d;cytarabine 15 mg/m2 subcutaneously once every 12 h, 14-21 d; and subcutaneously use of granulocyte colony-stimulating factor 200 μg·m-2·d -1 when neutrophil deficiency.The outcome and adverse effect were recorded after the treatment. Results The overall response rate in the low dose chemotherapy regimen group was 47.4% (9/19), 6 patients (31.6%) achieved complete response (CR). The overall response rate in the VPA group was 77.2% (17/22), 9 patients (40.9%) achieved CR. The overall response rate of the low dose chemotherapy in combination with VPA group was significantly higher than that in the low dose chemotherapy group (P＜0.05) while no difference was found in CR rate. The adverse effect of the low dose chemotherapy in combination with VPA regimen was tolerated. Conclusion With acceptable adverse effect, the low dose chemotherapy in combination with VPA regimen is effective for the treatment of intermediate and high-risk myelodysplastic syndrome. Long-term outcome needs further investigation.