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目的:观察阿米福汀联合地西他滨及CHG方案(阿糖胞苷+羟基喜树碱+重组人粒细胞刺激因子)治疗高危骨髓增生异常综合征(MDS)的疗效。方法:将42例高危MDS患者随机分为2组,第1组应用小剂量地西他滨及CHG方案治疗(19例),第2组应用阿米福汀联合地西他滨及CHG方案治疗(23例),14 d为1个周期,治疗2个周期后评估疗效,观察不良反应发生情况。结果:阿米福汀联合地西他滨及CHG方案治疗组总有效率与地西他滨及CHG方案组比较差异无统计学意义(78.3%∶78.9%,P>0.05)。近期死亡率方面,阿米福汀联合地西他滨及CHG方案治疗组明显低于地西他滨及CHG方案治疗组(0∶15.8%,P<0.05);Ⅲ~Ⅳ度白细胞减少和血小板减少发生率方面,阿米福汀联合地西他滨及CHG方案组明显低于地西他滨及CHG方案组(21.7%∶36.8%,69.6%∶89.5%,P<0.05);黏膜炎的发生率方面,阿米福汀联合地西他滨及CHG方案组明显低于地西他滨及CHG方案组(17.4%∶42.1%,P<0.05)。结论:阿米福汀联合地西他滨及CHG方案治疗中高危MDS安全有效,其近期死亡率降低,Ⅲ~Ⅳ度血液学毒性及黏膜炎等不良反应明显减轻。
Objective: To observe the effect of amifostine combined with decitabine and CHG regimen (cytarabine + hydroxycamptothecin + recombinant human granulocyte stimulating factor) in the treatment of high risk myelodysplastic syndrome (MDS). Methods: Forty-two patients with high-risk MDS were randomly divided into two groups. Group 1 was treated with low dose of decitabine and CHG regimen (n = 19), group 2 was treated with amifostine plus decitabine and regimen of CHG (23 cases), 14 days for one cycle. After 2 cycles of treatment, the curative effect was evaluated and the incidence of adverse reactions was observed. Results: There was no significant difference in the total effective rate between the combination of amifostine and decitabine and CHG regimen in comparison with decitabine and CHG regimen (78.3% vs 78.9%, P> 0.05). Recent mortality, amifostine combined decitabine and CHG regimen was significantly lower than that of decitabine and CHG regimen (0:15.8%, P <0.05); Ⅲ ~ Ⅳ leukopenia and platelet To reduce the incidence, the combination of amifostine and decitabine and CHG was significantly lower than that of decitabine and CHG (21.7% vs36.8%, 69.6%: 89.5%, P <0.05) In terms of incidence, the combination of amifostine and decitabine and CHG was significantly lower than that of decitabine and CHG (17.4% vs 42.1%, P <0.05). CONCLUSION: Amifostine combined with decitabine and CHG regimen is safe and effective in the treatment of middle-high risk MDS patients. The mortality rate of amifostine is reduced, and the adverse reactions of grade Ⅲ ~ Ⅳ hematologic toxicity and mucositis are significantly reduced.