CLAG方案治疗复发难治急性髓系白血病的疗效观察

目的:评价CLAG方案（2-CdA+Ara-C+G-CSF）治疗复发难治急性髓系白血病的疗效及安全性。方法:回顾性分析我中心2015年6月至2016年8月应用CLAG方案治疗的12例复发难治急性髓系白血病患者。结果:12例患者均系复发难治急性髓系白血病，根据NCCN急性髓系白血病指南（2017年第1版）细胞遗传学及分子生物学标记，进行危险度分级，其中预后良好组3例，预后中等组5例，预后不良组4例。所有患者均给予1疗程CLAG方案化疗，其中8例（72.7%）达到完全缓解（CR），2例（18.2%）达到部分缓解（PR），总有效率（OR）90.9%。所有患者均出现Ⅲ-Ⅳ级血液学毒性，主要毒副反应为粒细胞缺乏及血小板减少所导致的感染和出血，其中肺部感染8例（72.7%），侵袭性真菌病5例（45.5%），革兰阴性杆菌败血症2例（18.2%）。6例患者（54.5%）发生Ⅲ-Ⅳ级出血，1例因弥漫性肺泡出血早期死亡。化疗所致恶心呕吐、肝肾毒性、口腔黏膜炎等非血液学毒性均为Ⅰ-Ⅱ级。结论:CLAG方案治疗复发难治性急性髓系白血病有效率较高。化疗所致骨髓抑制较重，但合并感染、出血可控制，非血液学毒性轻微，安全性较好，可作为复发难治急性髓系白血病挽救性治疗的首选方案。

Clinical observation of CLAG regimen in treatment of relapsed or refractory acute myeloid leukemia

Objective:To evaluate the efficacy and safety of CLAG regimen (2-CdA+Ara-C+G-CSF) in the treatment of relapsed or refractory acute myeloid leukemia.Methods:Twelve patients with relapsed or refractory acute myeloid leukemia who were treated with one course of CLAG regimen from June 2015 to August 2016 were retrospectively reviewed.Results:Twelve patients were relapsed or refractory acute myeloid leukemia.According to the NCCN acute myeloid leukemia (2017 edition) cytogenetics and molecular biology markers，the risk classification was carried out.Among them，3 cases were good prognosis，5 cases of prognosis in the middle group，4 cases of poor prognosis group.After one course of CLAG regimen，8(72.7%) patients achieved complete remission (CR)，2(18.2%) patients achieved partial remission (PR)，and total effective rate (OR) was 90.9%.All the patients had grade Ⅲ-Ⅳ hematologic toxicity.The main adverse reactions were infection and hemorrhage caused by granulocyte deficiency and thrombocytopenia.Among them，8 cases (72.7%) were pulmonary infection and 5 cases (45.5%) were IFD，2 cases (18.2%) were Gram-negative bacilli sepsis.6 patients (54.5%) occurred Ⅲ- Ⅳ grade bleeding，1 case of diffuse alveolar hemorrhage early death.Chemotherapy caused by nausea and vomiting，liver and kidney toxicity，oral mucositis and other non-hematologic toxicity were Ⅰ-Ⅱ level.Conclusion:CLAG regimen is effective in the treatment of relapsed or refractory acute myeloid leukemia.Chemotherapy-induced bone marrow suppression heavier，but the merger infection，bleeding can be controlled，non-hematologic toxicity slightly，better security，can be used as a treatment of relapsed or refractory AML rescue treatment of choice.