沙利度胺联合G-HA方案诱导缓解老年或低增生急性髓细胞白血病26例的临床观察

目的探讨初治的老年或低增生急性髓细胞白血病（AML）患者采用沙利度胺联合粒细胞集落刺激因子（G-CSF）预激的小剂量高三尖杉酯碱（HHT）和阿糖胞苷（Ara-c）（G-HA）方案诱导缓解的疗效及毒副作用。方法选择年龄〉60岁或低增生AML初治患者共26例,采用沙利度胺联合G-HA方案诱导缓解治疗。沙利度胺100mg/d服3～4天后加量至200mg/d连续口服。G-CSF：200μg/m2d0～14天,治疗中白细胞计数〉20×109/L减量或停用,HHT：1mg/m2d1～14天,Ara-c：10mg/m2d1～14天皮下注射q12h。对完全缓解者（CR）后期可选择不同方案巩固疗效。对部分缓解者（PR）再经过第2疗程该方案治疗。结果第1疗程后11例患者获得（CR）,8例患者获得（PR）,7例患者未缓解（NR）。8例PR患者有3例患者经过第2疗程的治疗后获得CR,总有效率为73%,完全缓解率53.8%。结论初治老年人或低增生急性髓细胞白血病使用沙利度胺联合G-CSF预激的HA方案疗效较理想,毒副作用轻,值得进一步探讨及临床使用。

Clinical Observation of Remission Induction of Elderly or Hypoplastic Acute Myelogenous Leukemia with Regimen of G-HA Combined by Thalidomide in 26 Cases

Objective To investigate the efficacy and toxicity of the regimen-low-dose HHT and cytarabine（Ara-c）which were primed by granulocyte colony-stimulating factor（G-CSF）and combined by thalidomide in the untreated treatment of eld or hypoplastic acute myelogenous leukemia.Methods The 26 untreated patients over 60 years old or of hypoplastic acute myelogenous leukemia who were treated with the regimen of G-HA combined by thalidomide for remission induction were selected.Thalidomide was taken with dose of 100mg per day orally for 3～4 days and then increase dose to 200mg per day.G-CSF was injected subcutaneously with dose of 200μg per m2 form 0 day to 14th day and decrease dose or discontinue if leucocyte count is over 20×109/L.HHT was given with dose of 1mg per m2 from 1th day to 14th day by intravenous drip.Ara-c was injected subcutaneously per 12 hours with dose of 10mg per m2 from 1th day to 14th day.For patients with complete remission,various consolidation regimen can be applicated,but for patients with partial remission,2 cycles of the regimen should be given.Results After 1 cycle of the regimen,11 patients achieved complete remission（CR）,with 8 patients partial remission（PR）and 7 patients no remission（NR）.After 2 cycles of the regimen,3 of 8 patients with PR achieve CR.So,the total effective rate was 73% and CR rate was 53.8%.Conclusion The regimen is effective with little side effects and is worthy of further study and clinic application.