CAJ | 학술논문

目的：比较MEA与FLAG方案治疗难治性复发性急性髓系白血病( rrAML)的疗效及安全性,为rrAML的治疗提供依据。方法将68例rrAML患者随机分为2组,每组34例,MEA组按照米托蒽醌+依托泊苷+阿糖胞苷方案化疗；FLAG组按照氟达拉滨+阿糖胞苷+重组人粒细胞集落刺激因子方案化疗。1个疗程后评价两组化疗效果,并观察毒副反应发生情况,对两组完全缓解( CR)者采用 MS-PCR、Methylight-PCR 检测ID4基因甲基化水平。结果 FLAG组总缓解率高于MEA组(P<0．05)；FLAG组侵袭性真菌病、粒细胞缺乏发生率高于MEA组(P<0．05),粒细胞缺乏及发热持续时间长于MEA组(P<0．05)；FLAG组CR患者ID4基因甲基化水平低于MEA组(P<0．05)。结论 FLAG方案治疗rrAML效果优于MEA方案,其机制可能与FLAG能提高地西他滨的去甲基化水平有关,但FLAG方案感染及骨髓抑制较严重,临床应进一步优化。
목적：비교MEA여FLAG방안치료난치성복발성급성수계백혈병( rrAML)적료효급안전성,위rrAML적치료제공의거。방법장68례rrAML환자수궤분위2조,매조34례,MEA조안조미탁은곤+의탁박감+아당포감방안화료；FLAG조안조불체랍빈+아당포감+중조인립세포집락자격인자방안화료。1개료정후평개량조화료효과,병관찰독부반응발생정황,대량조완전완해( CR)자채용 MS-PCR、Methylight-PCR 검측ID4기인갑기화수평。결과 FLAG조총완해솔고우MEA조(P<0．05)；FLAG조침습성진균병、립세포결핍발생솔고우MEA조(P<0．05),립세포결핍급발열지속시간장우MEA조(P<0．05)；FLAG조CR환자ID4기인갑기화수평저우MEA조(P<0．05)。결론 FLAG방안치료rrAML효과우우MEA방안,기궤제가능여FLAG능제고지서타빈적거갑기화수평유관,단FLAG방안감염급골수억제교엄중,림상응진일보우화。
Objective To compare the efficacy and safety of MEA with FLAG in the treatment of rrAML,so as to provide reference for the treatment of rrAML. Methods 68 rrAML patients were randomly divided into 2 groups,MEA group ( n =34 ) was treated with mitoxantrone, etoposide, cytarabine;FLAG group ( n =34 ) was treated with fludarabine,cytarabine and restructuring human granulocyte colony-stimulating factor. The effect was evaluated and the incidence of adverse reactions was observed after a course of chemotherapy. Gene methylation ID4 level of complete remission( CR) of 2 groups was detected by MS-PCR,Methylight-PCR methods. Results CR rate of FLAG group was higher than that in MEA group(P<0. 05),but invasive fungal disease,agranulocytosis incidence of FLAG group were higher than that in MEA group(P<0. 05),neutropenia and fever lasting were longer than MEA group(P<0. 05). ID4 gene methylation levels in CR patients of FLAG group was lower than that in MEA group(P <0. 05). Conclusion FLAG regimen is better than MEA in the treatment of rrAML,it may be related to FLAG increasing the level of demethylation on capecitabine, but FLAG causes more serious infections and bone marrow suppression, it should be further optimized.