环孢素A联合沙利度胺治疗骨髓增生异常综合征的疗效观察

目的探讨环孢素A(CsA)联合沙利度胺治疗骨髓增生异常综合征的疗效。方法选取2011年1月~2013年6月住院治疗的骨髓增生异常综合征患者共62例,随机分为治疗组和对照组各31例。对照组予沙利度胺口服,初始剂量每天100 mg,如无不良反应则每周剂量递增50 mg/d,直至达最高剂量每天200 mg,然后改为维持剂量每天100~200 mg;治疗组同时加用CsA口服,CsA起始剂量为(2~3)mg/(kg·d),维持剂量5 mg/(kg·d),直到血液学反应出现或副作用发生。结果治疗6个月后,治疗组CR 13例(41.9%),PR 7例(22.6%),HI 3例(9.7%),NR 8例(25.8%),其有效率为74.2%,对照组以30例进行疗效评价,CR 9例(30%),PR 6例(20%),HI 1例(3.3%),NR 14例(46.7%),其有效率为53.3%,两组疗效组间比较,差异有统计学意义(χ2=6.237,P<0.05)。治疗组和对照组患者的Hb、PLT水平治疗6个月后均较治疗前明显上升,且治疗组患者的Hb、PLT水平较对照组上升更显著,差异有统计学意义(P<0.05)。结论环孢素A、沙利度胺二者联合用于治疗骨髓增生异常综合征可以提高其临床疗效,且无明显不良反应,值得推广和应用。

Efficacy of cyclosporine and thalidomide in treatment of myelodysplastic syndrome

Objective To investigate the effect of cyclosporine A （CsA） and thalidomide in treatment of myelodysplastic syndrome. Methods Selected 62 hospitalized patients with myelodysplastic syndrome from January 2011 to June 2013 and randomly divided into treatment group and control group, 31 cases in the control group were given oral thalidomide, the initial dose of 100mg, no adverse reactions such as the weekly dose escalation daily 50 mg/d, up to a maximum dose of 200 mg per day, and then a maintenance dose of 100-200 mg daily; treatment group added the oral CsA , CsA starting dose of （2-3）mg/（kg·d）, the maintenance dose of 5 mg/（kg·d）, until hematologic reactions or side effects occurred. Results After 6 months of treatment, the treatment group CR 13 cases （41.9%）, PR 7 cases（22.6%）, HI 3 cases （9.7%）, NR 8 cases （25.8%）, the effective rate was 74.2%, in the control group 30 cases for efficacy evaluation, CR 9 cases（30%）, PR 6 cases （20%）, HI 1 case（3.3%）, NR 14 cases （46.7%）, the effective rate was 53.3%, the differences were statistically significant between two groups （χ2=6.237, P 〈 0.05）. Hb, PLT levels of the treatment group and the control group of patients significantly increased than before treatment after 6 months of treatment, and patients treated with Hb, PLT levels rise more significantly than the control group,the difference was significant between two groups （P 〈 0.05）. Conclusion Cyclosporine and thalidomide treatment of myelodysplastic syndrome may improve clinical out-comes, and has no significant adverse reactions, worthy of promotion and application.