IDA-FLAG方案治疗复发难治的急性白血病

本研究探讨去甲氧柔红霉素（IDA）联合FLAG方案应用于复发难治急性白血病（AL）的疗效和不良反应。IDA＋FLAG方案具体为：IDA10—12mg／（m^2·d），第1-3天，氟达拉滨（Flu）30mg／（mm^2·d）（50mg／d），第1—5天，静脉滴注；阿糖胞苷（Ara—C）2000mg／（mm^2·d），第1—5天；粒细胞集落刺激因子（G—CSF）300μg／d，皮下注射，第0—5天。4例AL患者，男性，年龄32—44岁，其中急性髓细胞白血病（AML）3例，急性淋巴细胞白血病（ALL）l例，均为中大荆量阿糖胞苷巩固后复发或FLAG诱导无效。结果显示：4例接受IDA＋FLAG治疗方案1个疗程后均达到完全缓解（CR）。1例进行异基因外周血干细胞移植（allo—PBSCT）后4个月后发生血栓性血小板减少性紫癜死亡。1例缓解后10个月再次复发，2例持续CR时间为3和4个月。化疗的不良反应主要有骨髓抑制和粒细胞缺乏所致的感染，未见心脏毒性反应及其它严重的非造血系统不良反应。结论：IDA联合FLAG治疗复发难治的AL有一定疗效，尤其对于接受中大剂量Ara-C为主的方案后而复发或无效的AL患者有较高的CR率；此外，患者对此治疗方案的毒副作用可以耐受，这为进一步治疗创造时机。

IDA-FLAG Regimen in Treatment of Patients with Refractory or Relapsed Acute Leukemia

The objective of this study was to evaluate the efficacy and toxicity of the fludarabine combination with high-dose eytarabine （Ara C ）, idarubicin and granulocyte colony-stimulating factor （G-CSF） （IDA-FLAG regimen） in treatment of refractory/relapsed acute leukemia （AL） patients. 4 patients were male aged from 32 to 44 years, consisted of 3 cases of acute myeloid leukaemia（AML） and 1 cases of acute lymphocytic leukaemia（ALL）. All the patients were treated with idarubicin （10 -12 mg/m2/d, days 1 to 3 ）, fludarabine （50 mg/d, days 1 to 5 ）, cytarabine （2 g/mE/d, days 1 to 5 ） and granulocyte colony-stimulating factor （ G-CSF, 300 μg/d, days 0 to 5 ）. The results showed that after one course of induction therapy, 4 patients all achieved complete remission （CR）, in which 2 patients were in continuous CR after a follow-up of 3 and 4 months; 1 patient relapsed after 10 months and another one patient died of thrombotic thrombocytopenic purpura at 4 months after allogeneic peripheral blood stem cell transplantation. Myelosuppression and infections due to neutropenia were the most frequent adverse effects, severe nonhematologic toxicity and the early death were not observed in these patients. In conclusion, the IDA-FLAG regimen is effective in treatment of patients with refractory and relapsed AL, the adverse effects from this regimen were well tolerated by pateints, which gains time for further treatment.