目的：本研究旨在观察地西他滨联合CAG方案治疗老年及复发难治性急性髓细胞白血病(acute myeloid leukemia，AML)的临床疗效及不良反应。方法：回顾性分析了我科2015年1月至12月收治的15例老年性及复发难治性AML，应用地西他滨联合CAG方案(地西他滨15 mg·m−2·d−1，d1~5；阿克拉霉素10 mg/d，d3~6；阿糖胞苷10 mg/m2，q12 h，d3~9；G-CSF 300 mg/d，d0~9)，观察其治疗效果及不良反应。结果：老年患者6例，完全缓解(complete response，CR)4例，部分缓解(partial response，PR)1例，总有效率(overall response rate，ORR)：83.3%，复发难治患者9例，CR 3例，PR 2例，ORR 55.5%。所有患者中位总生存时间7(1~12)个月，中位无进展生存时间4(0~10)个月。血液学不良反应发生率为100%，严重出血发生率为10.5%，感染发生率为73.3%，无Ⅲ~Ⅳ级肝肾损害，无Ⅲ~Ⅳ级恶心、呕吐。结论：地西他滨联合CAG方案治疗老年性及复发难治性急性髓细胞白血病效果肯定，但感染及血液血反应的发生率较高，需注意检测并予以相应的支持治疗。
Clinical efficacy analysis of decitabine combined with CAG regiment on elderly and refractory or relapsed acute myeloid leukemia
Objective: To investigate the therapeutic effectiveness and side effect of decitabine combined with CAG regimen on elderly and relapse or refractory patients with acute myeloid leukemia (AML). Methods: 15 patients suffered from elderly or relapsed or refractory AML from January 2015 to December 2015 treated with decitabine combine with CAG regimen (decitabine 15 mg·m−2·d−1, d1~5, aclarubicin 10 mg/d, d3~6, Ara-C 10 mg/m2, q12 h, d3~9, G-CSF, 300 mg/d, d0~9), the therapeutic effectiveness and the side effect were observed. Results: Of 6 newly diagnosed elderly patients, 4 achieved complete remission (CR), 1 achieved partial remission (PR), the overall response rate (ORR) was 83.3%. Of 9 refractory or relapsed patients, 4 cases achieved CR, 2 cases achieved PR, and the ORR was 55.5%. The median overall survival time was 7 months (1~12 months). The median progression free survival time was 4 months (0~10 months). The hematologic toxicity rate was 100% and the severe bleeding rate was 10.5%, the incidence rate of infection was 73.3%. Neither liver and kidney injury, nor nausea and vomiting, at the degree of grade 3 or 4, was observed. Conclusion: Decitabine combined with CAG regiment can effectively treat elderly or refractory or relapsed AML, but hematologic toxicity and infections is severe, it is necessary to give appropriate monitoring and supportive treatment.