Economic analysis of granulocyte colony stimulating factor as adjunct therapy for older patients with acute myelogenous leukemia (AML): estimates from a Southwest Oncology Group clinical trial

Considerable morbidity, mortality, and economic costs result during remission induction therapy for elderly patients with acute myeloid leukemia (AML). In this study, the economic costs of adjunct granulocyte colony stimulating factor (G-CSF) are estimated for AML patients > 55 years of age who received induction chemotherapy on a recently completed Southwest Oncology Group study (SWOG). Clinical data were based on Phase III trial information from 207 AML patients who were randomized to receive either placebo or G-CSF post-induction therapy. Analyses were conducted using a decision analytic model with the primary source of clinical event probabilities based on in-hospital care with or without an active infection requiring intravenous antibiotics. Estimates of average daily costs of care with and without an infection were imputed from a previously reported economic model of a similar population. When compared to AML patients who received placebo, patients who received G-CSF had significantly fewer days on intravenous antibiotics (median 22 vs. 26, p = 0.05), whereas overall duration of hospitalization did not differ (median 29 days). The median cost per day with an active infection that required intravenous antibiotics was estimated to be $1742, whereas the median cost per day without an active infection was estimated to be $1467. Overall, costs were $49,693 for the placebo group and $50,593 for the G-CSF patients. G-CSF during induction chemotherapy for elderly patients with AML had some clinical benefits, but it did not reduce the duration of hospitalization, prolong survival, or reduce the overall cost of supportive care. Whether the benefits of G-CSF therapy justify its use in individual patients with acute leukemia for the present remains a matter of clinical judgment.     

Non-anthracycline based remission induction therapy for newly diagnosed patients with acute myeloid leukemia aged 60 or older

We assessed remission rates and toxicity in 24 consecutive elderly (age>or=60) patients with untreated Acute myeloid leukemia (AML) who received the anthracycline-free combination of fludarabine, cytosine arabinoside and G-CSF (FLAG) as initial induction chemotherapy at our center. CR was achieved following one cycle of FLAG in 14 patients (58%). Another four patients cleared blasts from their bone marrow by day 30 without complete platelet recovery. Three patients died from infections prior to neutrophil recovery (12%). No other grade 3/4 toxicities and no clinically significant mucositis were seen. No significant association was found between age, WBC and cytogenetic risk group with likelihood of achieving CR. Fifteen patients proceeded to consolidation therapy and seven patients received a stem cell transplant (six autologous, one allogeneic). Primary induction with FLAG in elderly AML patients achieves a high remission rate without prohibitive mucosal or cardiac toxicity and may thus be considered as an alternative to standard anthracycline-based regimens in this setting.     

Continuous drip infusion of low dose cytarabine and etoposide with granulocyte colony-stimulating factor for elderly patients with acute myeloid leukaemia ineligible for intensive chemotherapy

BACKGROUNDS AND OBJECTIVES: The optimal strategy for the management of elderly patients with acute myeloid leukaemia (AML) is still controversial. We previously reported the effectiveness of low dose cytarabine (Ara-C) and etoposide (VP-16) (AV therapy) for those elderly AML patients ineligible for intensive chemotherapy. We initiated the present feasibility study to improve the efficacy by using glanulocyte-colony stimulating factor (G-CSF) with AV therapy (AVG therapy). PATIENTS AND METHODS: The eligibility for enrolment was AML patients according to the World Health Organization (WHO) criteria who were over 60 years of age and who had difficulty in tolerating intensive chemotherapy due to their poor performance status (PS) or some comorbidities. They were given continuous drip infusion of Ara-C (20 mg/body) and VP-16 (50 mg/body) for 7-14 days, and were also simultaneously administered G-CSF (150 microg/m2) once daily. RESULTS: The median age of consecutively enrolled 25 patients was 73 years. Eighteen (72%) patients achieved complete remission (CR). The 1-year overall survival (OS) and the 3-year OS rates were 69% and 22%, respectively. The 1-year disease free survival (DFS) rate in CR patients was 44%. The major regimen related toxicities of grade 3 or 4 were only febrile neutropenia in 15 patients (60%). No regimen-related mortality was observed. CONCLUSION: AVG therapy was therefore found to be an effective and well-tolerated regimen for remission induction in elderly AML patients with poor PS or comorbidity.     

地西他滨联合减剂量MAG方案治疗老年急性髓系白血病的疗效及安全性北大核心

目的:评价地西他滨联合减剂量MAG方案[米托蒽醌(MTN)+阿糖胞苷(Ara-C)+粒细胞集落刺激因子(G-CSF)]治疗老年急性髓系白血病(acute myeloid leukemia,AML)患者的疗效及安全性。方法:本研究回顾性分析2016年06月至2020年12月收治的50例初诊老年急性髓系白血病患者,使用地西他滨联合MAG方案进行2个周期化疗,评估其疗效及安全性。结果:50例患者均完成2个周期化疗,骨髓造血恢复后进行评估。其中完全缓解(complete response,CR)29例(58.00%),部分缓解(partial response,PR)14例(28.00%),总缓解率(overall response rate,ORR)为86.00%(43/50)。所有患者均出现Ⅲ-Ⅳ级血液学毒性,其中24例(48.00%)患者粒细胞缺乏期出现感染,16例(32.00%)出现Ⅱ度出血。31例(62.00%)出现Ⅰ-Ⅱ级恶心、呕吐、脏器损害等非血液学毒性,但均可耐受,无治疗相关死亡病例。性别、年龄、KPS评分对完全缓解率无明确影响(P>0.05)。细胞遗传学良好者较细胞遗传学不良者缓解率高,差异具有统计学意义(P<0.05)。结论:地西他滨联合减剂量MAG方案治疗老年急性髓系白血病疗效确切,缓解率高,毒副反应可耐受,适用于临床广泛应用。     

Managing acute myeloid leukemia in the elderly

Acute myeloid leukemia (AML) is a disease of the elderly, with the majority of patients diagnosed in their 6th and 7th decade of life. Older patients with AML are less likely to achieve complete remission after induction chemotherapy, and they suffer from higher rates of leukemia relapse compared to younger cohorts. Suboptimal outcomes are the result of adverse biologic characteristics of leukemia in the elderly, as well as the presence of medical comorbidities and patient or physician preferences as to initiating treatment. In addition, there is a distinct lack of randomized, prospective data to guide management decisions for the treatment of AML in the elderly. Patients who are over age 75, with poor performance status, multiple comorbidities, or poor prognostic features, should be considered for a clinical trial or palliative therapy. Elderly patients who are candidates for standard induction chemotherapy and achieve complete remission are unlikely to benefit from intensive postremission therapy and should be referred to a clinical trial when possible. Further prospective trials are needed to identify a tolerable, effective treatment regimen for older patients with AML.     

Effect of low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor priming (CAG regimen) on the outcome of elderly patients with acute myeloid leukemia

The aim of this study was to evaluate the efficacy and toxicity of low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (G-CSF) protocol in elderly patients with acute myeloid leukemia (AML). A total of 50 elderly patients including 8 aged over 70 years were enrolled. All patients were treated with CAG regimen including low-dose cytarabine (10mg/m(2) every 12h, days 1-14), aclarubicin (10mg every day, days 1-8), and G-CSF (200 microg/m(2) every day, days 1-14) priming. The overall response rate was 72.0%, and 29 of 50 (58.0%) patients achieved complete remission, including 23 of 35 (65.8%) with previously untreated AML, 6 of 15 (40.0%) with refractory, relapsed or secondary AML, 4 of 8 (50.0%) aged over 70 years, 4 of 10 (40.0%) with unfavorable cytogenetic aberrations. The early death rate was 7.6%. The median overall survival was 14 months. Myelosuppression was mild to moderate, severe nonhematologic toxicity was not observed. Thus CAG priming regimen as the induction therapy is well tolerated and effective in elderly patients with AML.     

Salvage chemotherapy with low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor priming in patients with refractory or relapsed acute myeloid leukemia with translocation (8;21)

High expression levels of granulocyte colony stimulating factor (G-CSF) receptor were found in the leukemic cells of acute myeloid leukemia (AML) patients with t(8;21). Therapeutic significance of G-CSF receptor on chemotherapy remains to be defined. We evaluate the efficacy and tolerability of CAG regimen, consisting of concurrent use of G-CSF with low-dose cytarabine and aclarubicin, in 36 refractory/relapsed AML patients with t(8;21). The overall complete remission (CR) rate was 75% and median CR duration was 12 months. No significant treatment-related adverse events were observed. These data demonstrate that CAG regimen might be an alternative option in the treatment of AML with t(8;21), especially in older patients or patients with co-morbidities.     

SOHO State of the Art Updates and Next Questions |The Role of Maintenance Therapy in Acute Myeloid Leukemia

Acute myeloid leukemia (AML) is an aggressive disease predominantly affecting the elderly population. Although, up to 65% of patients with AML achieve a complete remission with standard induction chemotherapy, the majority of patients will relapse and succumb to the disease. Although maintenance therapy is a component of standard management for various hematological malignancies, such as acute lymphoblastic leukemia (ALL), acute promyelocytic leukemia (APL) or multiple myeloma, past studies investigating the role of maintenance therapy in AML were unable to demonstrate an advantage in overall survival, and therefore, it has not been an established practice in the treatment of AML. For patients, who are not candidates for stem cell transplant, effective AML maintenance therapies are needed in order to reduce the risk of relapse. Over the past decades, many investigators have examined the role of various maintenance strategies in AML; with the intention to prolong remission and overall survival. This review will provide an overview of prior and ongoing approaches and strategies to maintenance therapy for AML.     

Twice daily fludarabine/Ara-C associated to idarubicin,G-CSF and ATRA is an effective salvage regimen in non-promyelocytic acute myeloid leukemia

Preclinical data suggest that all-trans retinoic acid (ATRA) synergizing with granulocyte colony stimulating factor (G-CSF), can improve the effectiveness of chemotherapy in acute myeloid leukemia (AML). Fludarabine 15 mg/m² is the minimum dose able to optimize intensification with fludarabine-arabinosylcytosine regimen. In this study 52 patients with relapsed/refractory AML obtained a complete remission (CR) rate of 69.2% after FLAIRG regimen (Fludarabine and arabinosylcytosine twice daily, idarubicin, G-CSF, ATRA). This schedule resulted effective and tolerable enabling 53% of the responding patients to receive transplant procedure. FLAIRG regimen could be proposed as a “bridge” to transplant treatment in this poor risk setting.     

A single-center, retrospective study of management and outcome of 45 elderly AML patients, diagnosed in 2001

Acute myeloid leukemia (AML) predominantly affects older adults, a population with a poor prognosis, due to age, comorbidities and forms of disease. We present a retrospective study of 45 patients older than 60 years of age, with AML, who were diagnosed and/or treated in our clinic in the year 2001. Our study refers to 32 men, 63-80 years of age and 13 women, 62-85 years of age. Fourteen of them were diagnosed as de novo leukemia while 31 developed secondary leukemia, due to myelodysplasia, chronic myeloid leukemia and essential thrombocytemia. A therapeutic protocol that included 2 courses of induction chemotherapy with idarubicin 8mg/m2 for 3 days, aracytin 100 mg/m2 for 5 days and etoposide 75 mg/m2 for 5 days, followed by 2 courses of consolidation chemotherapy with aracytin 800 mg/m2/d for 4 days, was administered. In patients with acute promyelocytic leukemia we additionally administered all trans retinoic acid. Those with erythroleukemia also received erythropoietin, 10,000 IU 3 times a week. All patients received supportive therapy with blood products and G-CSF during blood marrow aplasia. Four patients refused therapy and three patients received only blood product support because of poor performance status. Nine out of the 38 patients who received chemotherapy (23.7%) achieved a complete remission after treatment, while, 13 out of 38 (34.2%) only a partial one (overall remission rate: 57.9 %). Ten patients relapsed in <6 months and 12 patients relapsed in >6 months. Patients who received only supportive treatment died 2-5 months after initial diagnosis. During therapy, 16 patients (42.1%) died due to: infection, cerebrovascular or gastrointestinal bleeding and acute myocardial infarction. In conclusion, it appears that a high percentage of the elderly patients with AML, despite the unfavourable prognosis, responded to chemotherapy (57.9%) and achieved longer survival durations compared to patients who refused therapy or received supportive treatment alone. Unfortunately, a large number of them exhibited serious complications during treatment, with a mortal outcome. Close follow-up and supportive care highly contributed to an improvement of treatment outcome in elderly patients with acute myeloid leukemia.     

CAG预激方案治疗急性髓系白血病及骨髓增生异常综合征

 目的　探讨小剂量阿糖胞苷（Ara-C）、阿克拉霉素（Acla）联合粒细胞集落刺激因子（G-CSF）（CAG方案）治疗急性髓系白血病（AML）及骨髓增生异常综合征（MDS）的临床疗效及患者不良反应。方法　选择初治或复发难治的AML与MDS患者54例,采用CAG方案化疗;获得完全缓解（CR）后选择不同方案交替巩固化疗。结果　CAG预激化疗治疗AML及MDS总有效39例（72.2 %）,CR 26例（48.1 %）,部分缓解（PR）13例（24.1 %）;化疗相关不良反应：粒细胞及血小板减少发生率40.7 %（22／54）,重症感染发生率24.1 %（13／54）。1例并发肝功能损害死亡。36例年龄＜60岁的患者总有效28例（77.8 %）,18例年龄≥60岁的患者总有效11例（61.1 %）,差异有统计学意义（P＜0.05）。结论　CAG方案治疗AML与MDS-原始细胞过多难治性贫血（RAEB）的疗效肯定,不良反应小,无病生存期长,是高效低毒的新型化疗方案。     

The detection of flow cytometric G-CSF receptor expression and it's effect on therapy in acute myeloid leukemia

The aim of this study was to evaluate G-CSF receptor (G-CSFr) expression on myeloid blasts, its prognostic significance and role in growth factor use and the safety and efficacy of G-CSF in the treatment of AML. Expression of G-CSFr, CD11a, CD11b, CD11c, CD13, CD33 and CD34 were analyzed with flow cytometry in 101 patients with AML aged 15-60 years. Results were reported as a percentage of positive cells. G-CSFr expression rate was found to be higher in M2 and M3 but lower in M5, M6 phenotypes, and in secondary leukemia. Patients were randomized for G-CSF use. Of 101 cases 51 received G-CSF. The overall remission rate was 68.7%. G-CSF use did not seem to have any effect on the remission rates. The median time to reach neutrophil counts > or = 1000/microliter in cases receiving G-CSF was 23 days, and 28 days in the control group (p < 0.01). G-CSF significantly reduced the number of febrile days (p < 0.01). Early and late relapses of 8 and 16 were observed during follow-up which was not effected by G-CSF use. In patients who were G-CSFr(+), G-CSF use did not alter overall survival rate. Univariate and multivariate analysis have revealed that not sex, G-CSF use or G-CSFr but age, FAB subtype and performance status at diagnosis were the important factors on both overall and disease free survival. We have demonstrated no beneficial effect of G-CSFr analysis on in vivo G-CSF use.     

小剂量CHG预激方案治疗老年人急性髓系白血病的临床研究

 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）200 μg／m2后,应用14 d,HHT 1 mg／m2,第1天至第14天,1次／d;Ara-C 10 mg／m2,第1天至第14天,皮下注射,每12 h 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。     

Haematopoietic cytokines in the biology and treatment of acute myeloid leukaemia

In acute myeloid leukaemia (AML), age has a definite effect on the biology of the disease and also determines the outcome of chemotherapy. AML cells constitutively express mRNA and produce several haematopoietic cytokines. The haematopoietic cytokines: SCF, IL-3, GM-CSF and G-CSF induce leukaemic colonies or activate DNA synthesis in about 80% of AML cases. Both M-CSF and thrombopoietin stimulated AML cell proliferation is seen in vitro in about 50% of cases. Both IL-6 and IL-11 showed little proliferative activity on primary AML cells. The combinations of these cytokines were synergistic in stimulating the proliferation of AML cells. On the other hand, the inhibitory haematopoietic cytokines: TNF-alpha, TGF-beta, IFN-gamma and IL-4 have shown multiple effects on AML blast cell proliferation. In several in vitro systems, haematopoietic cytokines have failed to induce maturation of AML blasts. Only in AML with t(8;21), G-CSF has induced granulocytic maturation of AML blasts in vitro. AML cells with chromosomal abnormalities involving the 21q22 region differentiate in vitro into eosinophils in the presence of IL-5. IL-6 and IFN-alpha have induced megakaryocytic differentiation of blast cells from acute megakaryoblastic leukemia (M7) patients. The haematopoietic cytokines: SCF, IL-3 and GMCSF have protected in vitro AML cells from chemotherapy-induced apoptosis. Many clinical studies have been recently reported evaluating the effect of the haematopoietic cytokines: GM-CSF, G-CSF, IL-3 and PIXY321 as adjuncts to the chemotherapy of AML patients. Most studies have shown these haematopoietic cytokines to be well-tolerated and effective in augmenting neutrophil recovery in elderly AML patients when given after chemotherapy. On the other hand, considerable number of studies using these cytokines before and during chemotherapy to recruit AML cells into cell cycle and thus make them more susceptible to chemotherapy have reaveled no benefit. Several clinical trials have shown promising results after the use of IL-2 either as remission induction therapy in refractory and/or relapsed AML patients or as post-remission consolidative immunotherapy. Haematopoietic cytokines administered after chemotherapy can shorten the duration of neutropenia and hospitalisation without a significant effect on treatment outcome. On the other hand, their use before and during chemotherapy has yielded no benefit, and instead have led to delay of platelet recovery and worse survival rate in some elderly AML patients.     

Prognostic Factors in Elderly Patients with Acute Myeloid Leukaemia

Acute myeloid leukaemia (AML) is predominantly a disease of the elderly; the median age of incidence is 64 years, and 60% of all cases are over 60. With improved chemotherapy regimens and maximal supportive care, remission rates of up to 60% may be achieved in selected elderly patients. Whilst intensive chemotherapy is the treatment of choice for fit patients, it may be inappropriate for debilitated patients with poor prognosis disease in whom supportive care or palliative chemotherapy may be more suitable. AML in the elderly exhibits biological differences from AML in younger patients, and elderly patients may be unable to withstand the rigors of the intensive treatment regimens given to younger patients.     

Low-dose total body irradiation and G-CSF without hematopoietic stem cell support in the treatment of relapsed or refractory acute myelogenous leukemia (AML), or AML in second or subsequent remission

Purpose: Patients with relapsed acute myelogenous leukemia (AML), who are not eligible for bone marrow transplantation, have a poor prognosis when treated with chemotherapy alone. Total body irradiation (TBI) is an effective modality against AML when used in doses of 1000–1400 cGy with hematopoietic stem cell support. We undertook a phase I study of TBI with granulocyte–colony-stimulating factor (G-CSF) support, without stem cell support in patients with AML either in relapse or second or subsequent remission.

Methods and Materials: Patients with relapsed AML, or AML in second or subsequent remission were treated in a phase I study of TBI followed by G-CSF. The first dose level was 200 cGy. After the initial cohort of patients it was clear that patients with overt leukemia did not benefit from this treatment, and subsequent patients were required to be in remission at the time of TBI.

Results: Eleven patients were treated, 4 in overt relapse, and 7 in remission. 200 cGy was used in all, and dose escalation was not possible due to prolonged thrombocytopenia in all patients but one. Neutrophil recovery was adequate in those patients who remained in remission after TBI. Patients with overt leukemia had transient reduction in blast counts, but rapid recurrence of their leukemia. Patients treated in remission had short remissions, with the exception of one patient who is in remission 32 months after treatment.

Conclusion: There is some antileukemic effect of TBI even at 200 cGy, though this dose appears to be too low to help a significant number of patients. If TBI is to be escalated without stem cell support, then a thrombopoietic agent will need to be used.     

Clofarabine in the Treatment of Elderly Patients with AcuteMyeloid Leukemia

Background: Elderly patients with acute myeloid leukemia (AML) have a poor outcome because of comorbidities,poor tolerance to intensive chemotherapy and inherently more resistant disease. Clofarabine is asecond generation nucleoside analogue which has shown promising activity in elderly patients with AML. Thisstudy was conducted to review the outcome of treatment with clofarabine in a group of such patients. Methods:The records of 5 elderly patients who were diagnosed to have AML and treated with clofarabine over a 12month period were reviewed retrospectively. Results: There were 2 female and 3 male patients with a medianage of 68 years (range 65-82). At the time of treatment, 2 patients had newly diagnosed AML not consideredsuitable for intensive therapy, while 3 patients had partial or no response to conventional chemotherapy. Theoverall response rate was 100%, all patients achieving a complete remission. Induction and consolidation werewell tolerated. All patients developed neutropenia with a median duration of 20 days (range 17-42). One patientdeveloped hand and foot syndrome and a generalized rash but recovered. There was no mortality and all patientsremained in remission after a median follow-up of 5.2 months (Range 3-10). Conclusion: Clofarabine (alone orin combination) is active in elderly AML patients with an acceptable safety profile and should be considered apotential option in this group.     

大剂量粒系集落刺激因子使老年急性髓系白血病患者受益

目的 探讨老年急性髓系白血病（AML）化疗期间预防性大剂量（>5 μg/kg）和标准剂量（5 μg/kg）使用G-CSF对感染、输血情况的影响。方法 回顾性对比分析82例老年AML 273个化疗周期中两组G-CSF进行支持治疗中抗生素和抗真菌药物使用情况、发热天数、发热程度、粒缺时间、输血情况等。结果 273个化疗周期中合并感染223次（81.7%）,因感染中断治疗11例（13.4%）;标准剂量组中2例（2.3%）患者在诱导治疗期间死亡。亚组分析发现,大剂量组可明显缩短巩固治疗期间粒缺时间、发热天数及减少抗真菌药物的使用。结论 大剂量G-CSF可提高老年AML患者化疗期间的安全性、耐受性。     

G-CSF in the Biology and Treatment of Acute Myeloid Leukemias

Granulocyte colony-stimulating factor (G-CSF) is an hemopoietic growth factor produced by fibroblasts, monocytes and endothelial cells. The role of G-CSF in the biology of acute myeloid leukemia (AML) has been investigated by several authors, who have demonstrated receptor mediated enhanced proliferation of AML blasts in vitro, in the presence of G-CSF. This effect is further increased by addition of other cytokines such as GM-CSF, IL3, IL4, Stem cell factor (SCF), while Tumor Necrosis Factor (TNF) and Transforming Growth Factor β1 (TGF β1) seem to exert an inhibitory activity. An autocrine production of G-CSF by AML cells, a paracrine production by accessory cells and a protective effect displayed by G-CSF against programmed cell death could partially contribute to explain the pathogenesis of AML. In vivo, G-CSF has been used after chemotherapy in AML, in order to improve hemopoietic recovery in patients at high risk of infection. Current studies are focusing on better definition of the role of G-CSF, as such or combined with other biological modifiers, in dose intensification and autologous bone marrow or peripheral blood stem cell transplantation.     

低剂量地西他滨联合减量IAG方案治疗老年骨髓增生异常综合征转化的急性髓系白血病疗效观察

目的:观察低剂量地西他滨联合减量IAG方案（IDA、Ara-C、G-CSF）诱导治疗老年骨髓增生异常综合征（myelodysplastic syndrome,MDS）转化的急性髓系白血病（acute myeloid leukemia,AML）的疗效及安全性。方法:回顾性分析我中心2015年7月至2017年9月收治的53例老年MDS转化的AML患者,采用低剂量地西他滨联合减量IAG方案诱导治疗,观察疗效并评价其安全性。结果:所有53例患者均完成2疗程化疗,骨髓造血恢复后复查骨髓象评估疗效。其中完全缓解（complete remission,CR）23例（43.4%）,部分缓（partial remission,PR）11例（20.8%）,总有效率（overall remission rate,ORR）64.2%（34/53）。所有患者均出现Ⅲ-Ⅳ级血液学毒性,主要合并症为粒细胞减少所致的感染及血小板减少所致的出血。恶心呕吐、肝肾功损害、心脏毒性等非血液学毒性均可耐受,无治疗相关死亡。性别、年龄、KPS评分对完全缓解率无明确影响,细胞遗传学良好者较细胞遗传学不良者缓解率高,差异有统计学意义（P＜0.05）。结论:低剂量地西他滨联合减剂量IAG方案治疗老年MDS转化的AML疗效确切,缓解率高,不良反应可耐受,临床值得推广。