地西他滨治疗骨髓增生异常综合征和急性髓细胞白血病临床观察

目的探讨地西他滨治疗骨髓增生异常综合征（MDS）和急性髓细胞白血病（AML）的临床疗效和安全性。方法收集2011年1月至2013年7月接受地西他滨15mg／（m2·d），第1—5天，静脉滴注持续1h以上1单药或联合CAGf阿糖胞苷（Ara-C）、阿克拉霉素（Acla）、粒细胞集落刺激因子（G-CSF）]方案治疗的20例MDS和AML患者的临床资料，评价其疗效和不良反应。结果20例患者中完全缓解（CR）4例，部分缓解（PR）8例，稳定（SD）及进展（PD）8例，总有效率为60．0％（12／20）。其中12例AML患者中CR2例，PR5例，总有效率为58.3％（7／12），8例MDS患者中CR2例，PR3例，总有效率为62．5％（5／8）。1例MDS．难治性贫血伴环状铁粒幼细胞患者和2例慢性粒一单核细胞性白血病患者输血依赖情况有所改善。14例患者出现Ⅲ－Ⅳ度骨髓受抑，发生率为70．O％（14／20）。总感染率为35．0％（7，20），其中肺部感染率为20．0％（4／20），患者经积极抗感染、刺激造血及输血等支持治疗后感染控制。1例患者出现化疗相关死亡。20例患者均未出现严重肝功能损害及出血。结论地西他滨单药或联合CAG方案治疗MDS和AML有一定疗效，可廷缓疾病进展；患者对化疗不良反应均能耐受．且化疗相关病死率低。

Clinical observation of decitabine for myelodysplastic syndrome and acute myeloid leukemia

Objective To explore the clinical efficacy and safety of decitabine for myelodysplastic syndrome （MDS） and acute myeloid leukemia（AML）. Methods Collecting the clinical data of 20 patients with MDS/AML from January 2011 to July 2013 ,who were received the therapeutic regimen with decitabine 15mg/（m2. d） by intravenous infusion over 1 h for five consecu tire days or combined with CAG cytosine arabinoside （Ara-C）, aclacinomycin （Acla） and granulocyte colony stimulating factor （G-CSF）]. The clinical efficacy and adverse effects were evaluated. Results Among the 20 patients, 4 cases were of complete re- mission （CR）, 8 cases achieved partial remission （PR） and 8 cases of stable disease （SD） and progressive disease （PD） with the total effective rate of 60% （12/20）. Among the 12 patients with AML, 2 cases were of CR and 5 cases of PR with the total effective rate of 58.3%（7/12）. Among the 8 patients with MDS ,2 cases were of CR and 3 cases of PR with the total effective rate of 62.5% （5/8）. The transfusion dependency was improved in 3 patients, in which, one with MDS-refractory anemia with ring sideroblast and two with chronic myelomonocytic leukemia. Grade m-IV bone marrow depression occurred in 14 cases with incidence rate of 70% （14/20）, and the total incidence rate of infection was 35% （7/20）, including lung infection of 20% （4/20）, the infection was con- trolled after active supportive treatments with anti-infection,hematopoietic stimulating and blood transfusion. No severe livery in- jury and bleeding occurred. 1 patient died due to chemotherapy. Conclusion Decitabine or combined with CAG regimen can ef- fectively treat MDS/AML in some extent and delay the development of diseases. The patients can tolerate the adverse effect in chemotherapy with a low mortality rate.