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。

Inductive chemotherapy with low-dose CHG stimulating regimen in elderly acute myeloid leukemia

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.