CLAG方案和MEA方案治疗复发/难治急性髓系白血病的疗效比较

目的:探讨CLAG方案（克拉屈滨+阿糖胞苷+重组人粒细胞刺激因子）和MEA方案（米托蒽醌+依托泊苷+阿糖胞苷）在治疗难治/复发急性髓系白血病（RR-AML）患者中的疗效及其安全性，并分析在难治性AML患者中应用两种方案的优劣性，为RR-AML的治疗提供依据。方法:回顾性分析44例RR-AML患者，比较CLAG组（n=20）和MEA组（n=24）临床疗效，并观察两种方案的不良反应发生情况，进一步比较CLAG方案和MEA方案在治疗20例难治性AML患者中的临床疗效。结果:CLAG组患者的完全缓解(CR)率40.0 %（8/20）高于MEA组29.2 %（7/24），但是两组之间比较，差异并无统计学意义（χ2=1.104，P=0.766）；CLAG组患者中位无进展生存期（PFS）和总生存期（OS）均优于MEA组，并且差异性显著有统计学意义（χ2=6.834，P=0.004；χ2=6.883，P=0.001）；CLAG组肺部感染发生率较MEA组高，且差异有统计学意义（χ2=8.826，P=0.033），粒细胞缺乏发生率亦高于MEA组，但差异无统计学意义（P＞0.05）。难治性AML患者CLAG方案治疗的中位OS、PFS均优于MEA方案治疗患者，但差异均无统计学意义（χ2=1.037，P=0.820；χ2=0.463，P=1.000）。结论:CLAG方案可作为RR-AML患者一线挽救治疗方案，不良反应可控，以期再次达到CR，获得造血干细胞移植机会。

The effectiveness comparison between the CLAG regimens and MEA regimens for the treatment of patients with relapsed or refractory acute myeloid leukemia

Objective:To explore the clinical efficacy and safety of CLAG and MEA regimen in patients with relapsed or refractory acute myeloid leukemia(AML),and to analysis for the two regimens in patients with refractory acute myeloid leukemia and inferiority.Methods:Retrospective analysis of 44 cases of patients with relapsed or refractory AML,compare the curative effect between CLAG group(n=20) and MEA group(n=24),and further comparison of CLAG and MEA clinical curative effect in patients with refractory AML(20 cases).Results:The overall CR rates for CLAG group was 40.0%（8/20）higher than MEA group 29.2%（7/24）,and there was no significant difference between two groups（χ2=1.104，P=0.766）.The median progression free survival(PFS) and overall survival(OS) for CLAG group were significantly better than the MEA group（χ2=6.883，P=0.001,χ2=6.834，P=0.004）.The incidence of pulmonary infection in group CLAG was higher than that in group MEA,and there was significant difference between two groups(χ2=8.826,P=0.033).The rate of granulocyte deficiency was also higher than that in group MEA,but there was significant difference between two groups(P＞ 0.05).The median OS and PFS were no significantly better than the MEA regimens in refractory AML（χ2=1.037，P=0.820,χ2=0.463，P=1.000）.Conclusion:CLAG regimens can be used as refractory or recurrent AML patients preferred solution,to prolong the CR of patients,which can increase the choice of patients with hematopoietic stem cell transplantation.