地西他滨联合沙利度胺对MDS患者的病态造血及疗效的影响

doi:10.3969/j.issn.1000-8535.2022.02.004

摘要/Abstract

摘要： 目的探讨地西他滨(DAC)联合沙利度胺对骨髓增生异常综合征(MDS)患者的病态造血及疗效的影响。方法以本院自2014年6月—2020年5月收治的MDS患者为研究总体,行便利抽样法选择60例于收治期间行输血、抗感染及诸如促红生成素 (EPO)+集落刺激因子(CSF)等细胞因子治疗效果不佳的MDS开展研究,按完全区化原则设立对照组及观察组,予以对照组沙利度胺治疗,观察组则于对照组基础上施予地西他滨(DAC)行联合治疗,比较2组疗效、血象相关指标、病态造血改善情况及预后转归。结果观察组ORR为51.61%,与对照组的26.67%相比更高,差异有统计学意义(P<0.05);经治疗,2组血小板计数(PLT)、血红蛋白(HGB)、中性粒细胞计数(ANC)水平均见一定程度上升,骨髓原始细胞(bls)水平则见下降,观察组PLT、HGB、ANC相较于对照组更高,bls水平则更低(P<0.05);于2020年5月截止随访,随访时间8~96个月,中位随访时间68个月。于治疗及随访中行骨髓形态检查及染色体核型鉴别均表现正常。关于病态造血改善情况,2组T1率比较,差异无统计学意义(P>0.05);观察组国际预后积分系统评分整体优于对照组(P<0.05);2组Ⅰ~Ⅳ级不良反应比较,差异无统计学意义(P>0.05);观察组5年总生存时间率为63.33%,相较于对照组的36.67%更高(P<0.05)。结论相较于单一沙利度胺治疗,应用地西他滨联合沙利度胺治疗MDS,疗效更为确切,且可改善血象指标,拥有一定T1率,且预后转归表现较好。

关键词: 骨髓增生异常综合征, 地西他滨, 病态造血, 促红生成素, 集落刺激因子

Abstract: Objective To investigate the impact of decitabine (DAC) combined with thalidomide on dyshaematopoiesis and efficacy in patients with myelodysplastic syndrome (MDS). Methods Patients with MDS admitted to our hospital from June 2014 to May 2020 were selected as the research population.Among them, 60 MDS cases were selected by convenience sampling method, which had poor therapeutic effect with treatment of blood transfusion, anti-infection and cytokines treatments such as erythropoietin (EPO)+ colony stimulating factor (CSF). The control group and the observation group were set up according to the principle of complete block, and the control group was treated with thalidomide while the observation group was treated with decitabine (DAC) on the basis of the control group.The efficacy, hemogram-related indicators, improvement of dyshaematopoiesis and prognosis outcomes were compared between the two groups. Results The overall response rate (ORR) of the observation group was higher than that of the control group (51.61%vs 26.67%, P<0.05). After treatment, the levels of platelet (PLT), hemoglobin (HGB) and absolute neutrophil count (ANC) in the two groups were increased to a certain extent while the level of bone marrow blasts(bls) was decreased, and the levels of PLT, HGB and ANC of the observation group were higher than those of the control group while the level of bls was lower (P<0.05). The follow-up deadline was May 2020, and the follow-up time was 8-96 months and the median follow-up time was 68 months.During treatment and follow-up, bone marrow morphology examination and chromosome karyotype identification results were normal.Regarding the improvement of dyshaematopoiesis, the difference in T1 rate between the two groups was not statistically significant (P>0.05). The revised International Prognostic Scoring System prognosis score of the observation group was better than that of the control group (P<0.05). There were no statistically significant differences between the two groups in terms of grade I~IV adverse reactions (P>0.05). The 5-year overall survival rate of the observation group was 63.33%, which was higher than 36.67%of the control group (P<0.05). Conclusion Compared with thalidomide only treatment, the application of decitabine combined with thalidomide in the treatment of MDS had a more accurate efficacy, improved hemogram indicators, and had a certain T1 rate and good prognosis outcomes.

Key words: myelodysplastic syndrome, decitabine, dyshaematopoiesis, erythropoietin, colony stimulating factor

葛晓华, 赵小强. 地西他滨联合沙利度胺对MDS患者的病态造血及疗效的影响[J]. 广州医药, 2022, 53(2): 17-22.

GE Xiaohua, ZHAO Xiaoqiang. Effect of decitabine combined with thalidomide on dyshaematopoiesis and efficacy in patients with MDS[J]. Guangzhou Medical Journal, 2022, 53(2): 17-22.

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