蔡嘉惠 谭健锋 翟晓 吴秉毅 董瑞红

【摘要】 目的：研究地西他滨联合CAG（盐酸阿柔比星+阿糖胞苷+粒细胞集落刺激因子）治疗TET2阳性老年急性髓细胞白血病（acute myelocytic leukemia，AML）的效果。方法：选取2013年1月-

2020年9月本院收治的46例TET2阳性老年AML患者，其中2013年1月-2018年1月TET2阳性老年AML患者23例为对照组实行CAG方案，2018年6月-2020年9月TET2阳性老年AML患者23例为观察组实行地西他滨+CAG方案，比较两组疗效。结果：用药后，两组CD3+、CD4+及CD4+/CD8+指标均降低，且观察组均低于对照组，差异均有统计学意义（P<0.05）。观察组总有效率较对照组更高，差异有统计学意义（P<0.05）。两组白细胞恢复时间、血小板输注量比较，差异均无统计学意义（P>0.05）。两组各项不良反应率比较，差异均无统计学意义（P>0.05）。结论：地西他滨联合CAG方案治疗TET2阳性老年AML患者能提高疗效，不会增加不良反应，值得推广。

【关键词】 地西他滨 CAG方案 TET2阳性 急性髓细胞白血病 细胞免疫

Effect of Decitabine Combined with CAG on TET2 Positive Senile Acute Myeloid Leukemia/CAI Jiahui， TAN Jianfeng， ZHAI Xiao， WU Bingyi， DONG Ruihong. //Medical Innovation of China， 2021， 18（07）： 0-080

[Abstract] Objective： To study effect of Decitabine combined with CAG （Arubicin Hydrochloride+Cytara Bine+granulocyte colony stimulating factor） on TET2 positive senile acute myeloid leukemia （AML）. Method： A total of 46 elderly patients with TET2 positive AML admitted to our hospital from January 2013 to September 2020 were selected. Among them， 23 elderly patients with TET2 positive AML from January 2013 to January 2018 were treated with CAG scheme in the control group， and 23 elderly patients with TET2 positive AML from June 2018 to September 2020 were treated with Decitabine+CAG scheme in the observation group. The efficacy of the two groups was compared. Result： After treatment， CD3+， CD4+ and CD4+/CD8+ indexes were decreased in both groups， and the observation group of those were lower than those in the control group， the differences were statistically significant （P<0.05）. The total effective rate of the observation group was higher than that of the control group， the difference was statistically significant （P<0.05）. There were no significant differences in WBC recovery time and platelet infusion volume between the two groups （P>0.05）. There was no statistical significance in adverse reaction rates between the two groups （P>0.05）. Conclusion： Decitabine+CAG regimen in the treatment of TET2 positive elderly AML patients can improve the efficacy， cant increase adverse reactions， which is worthy of praise.

[Key words] Decitabine CAG regimen TET2 positive Acute myeloid leukemia Cellular immunity

First-authors address： Shunde Hospital of Southern Medical University （The First Peoples Hospital of Shunde）， Foshan 528308， China

doi：10.3969/j.issn.1674-4985.2021.07.019

研究表明，臨床常见的急性髓细胞白血病（acute myeloid leukemia，AML），属于高度异质的血液系统恶性肿瘤[1]，在老年群体较常见，分析原因与自身免疫状态差、脏器功能衰弱等因素有关，患病后典型特征为骨髓中原始细胞异常增生，对正常造血产生抑制，可对肝、脾或淋巴结等脏器造成侵犯，表现为贫血、出血、感染及髓外浸润等症状[2-3]，分析患者病理机制发现，此病多与遗传、环境及异常DNA甲基化有关。有研究显示，TET2基因在老年AML群体中突变率相对较高，突变率为10%～17%，若AML患者合并TET2阳性，提示预后不佳[4]。因此结合基因结果选择合适的治疗方案是关键，对降低病死率、改善预后有积极作用。刘晓等[5]证实，异基因造血干细胞移植术是根治AML的方法，但老年群体体质较差，无法耐受异基因造血干细胞移植术，临床上多采用化疗控制疾病，CAG方案为老年AML患者的常用方案，可达到一定的疗效，缓解患者症状，提高生活质量，但总体有效率不算高，且短期内易出现疾病复发，效果不理想[6-7]。鉴于……