FLAG方案治疗难治复发急性白血病的临床分析

 目的 观察FLAG方案治疗难治复发急性白血病的临床效果。方法 17例复发难治急性白血病患者接受FLAG方案治疗，包括：氟达拉滨（Flud）30 mg·m- 2·d-1，阿糖胞苷（Ara-C）0.5～2.0 g／d，粒细胞集落刺激因子（G-CSF）250～300 μg／d，连用5 d。结果 原发耐药组7例中有4例CR；早期复发组6例中2例CR，1例PR；晚期复发组4例中1例CR，1例PR。不同疾病类型中，急性非淋巴细胞白血病（ANLL）组10例有7例获得CR；急性淋巴细胞白血病（ALL）组共7例， 1例CR，1例PR。按接受Ara-C剂量不同将患者分为两组，标准剂量组（Ara-C 1.5～2.0 g／d）7例，CR6例；降低剂量组（Ara-C 0.5～1.0 g／d）10例，仅1例获得CR，2例PR。在不良反应方面，粒细胞缺乏中位持续时间为21.5 d（16～34 d）；从化疗开始直至血小板＞20×109／L的中位时间为22 d（14～32 d）。在非血液学不良反应中，主要为感染（15／17），其次为药物热（5／17）。在减低剂量C组中，各种不良反应发生没有明显下降。 结论 FLAG对难治性ANLL有较好的疗效，且不良反应较轻。降低Ara-C剂量会显著降低治疗有效率，且患者不良反应没有明显减少。

The effects of FLAG regimen for refractory or relapsing acute leukemia

Objective To investigate the effects of FLAG regimen for refractory or relapsing acute leukemia. Methods FLAG regimen (Fludarabine 30 mg·m-2·d-1, 5 days, Ara－C 0.5 ~1.5 g/d, 5 d ays, and G-CSF 250～300 μg·d-1, 5 days) were used to treat seventeen17 cases of refractory or relapsed acute leukemia. Results Four patients recerived CR in seven cases who were primary resistant to treatment; two patients received CR and one patient received PR in six cases who were early relapsed; and one patient re－ceived CR and one patient received PR who were lately relapsed. Seven cases received CR for ten cases of ANLL, while only one case received CR and one case received PR for seven cases of ALL. Total response rate of seven patients who received classic FLAG (six patients CR) was higher than those ten cases received low-FLAG (one patient CR and one patient PR). Median time to neutrophil recovery (>500 /μl) was 21.5 days (16~ 34 days), while a platelet count >20×109/L was reached after 22 days (14 ~ 32 days). The nonhematological toxicity mainly consisted of infection (15/17) and fever (5/17). There was no significant difference in the toxici－ty classic FLAG group and low-FLAG group. Conclusion FLAG shows obvious effects for refractory and re－lapsing acute non lymphocytic leukemia and the toxicity is mild. Low-FLAG gains poor effects and the toxity is the same as classic FLAG.