CLAG方案治疗难治复发急性髓系白血病的初步研究

目的观察CLAG方案治疗难治复发急性髓系白血病（AML）的效果和不良反应。方法2014年1月至2015年1月北京隆福医院和协和医院收治的难治复发AML患者12例，均给予1个疗程CLAG方案化疗，观察其疗效和不良反应。结果12例患者，男性6例，女性6例，中位年龄35岁（14～68岁）。按照FAB分型，M1 1例，M28例，M51例，M41例，粒淋混合细胞白血病（HAL）1例。分子遗传学方面，AML1／ETO阳性3例，FLT-ITD突变3例。难治7例，复发5例，既往化疗中位疗程数5个（1～15个）。经CLAG方案1个疗程化疗后，复查骨髓涂片10例（83．33％）患者完全缓解（CR），1例死亡，1例未缓解。6例有分子遗传学异常者均转为阴性。11例患者均出现骨髓抑制并不同部位感染，3例CR后患者已完成异基因造血干细胞移植。结论CLAG方案对难治复发AML疗效确切，患者耐受性好。一旦获得CR，应该尽快安排异基因造血干细胞移植。

Preliminary study on CLAG regime in the treatment of patients with refractory and relapsed acute myeloid leukemia

Objective To observe the efficacy and adverse events of CLAG regime for the treatment of patients with refractory and relapsed acute myeloid leukemia (AML).Methods Efficacy and adverse events in patients with refractory and relapsed AML who were treated with one course of CLAG from January 2014 to January 2015 were retrospectively analyzed.Results The patients included 6 males and 6 females,with a median age of 35 years old (range 14-68 years old).According to FAB subtype,there were 8 patients with M2,1 with M1,1 with M4,1 with M5,and 1 with hybrid acute leukemia respectively.Six patients were identified as molecular subtype abnormalities,including 3 in AML1/ETO fusion and 3 in FLT3-ITD mutation.There were 7 patients with refractory and 5 with relapsed,and the median previous chemotherapy courses were 5(1-15).After one course of GLAG regime,10 patients achieved hematological complete response,1 case died,1 case unremnitted.11 patients had grade 4 neutropenia and thrombocytopenia and infection with different sites without treatment-related mortality.Three patients received allo-hematopoietic stem cell transplantation.Conclusions CLAG regime is effective and well tolerable in patients with refractory and relapsed AML.Allo-hematopoietic stem cell transplantation should be performed as soon as possible when patients achieved complete response.