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背景与目的:FLAG方案用于治疗难治复发性急性非淋巴细胞性白血病(acutenon-lymphocyticleukemia,ANLL)已有多年,大多报道的CR率为50%～64%。本研究探讨改良FLAG方案(减少合并应用Ara-C剂量并在化疗前不用G-CSF)能否达到同样疗效,并减轻不良反应。方法:33例成人急性白血病中难治性ANLL16例,难治性急性淋巴细胞白血病(ALL)12例,复发性ALL5例。全部病例接受氟达拉宾30mg·(m2·d)-1,静滴,第1～5天;其中合并Ara-C200mg·d-1有18例,Ara-C500mg·d-1有5例,Ara-C1000mg·d-1有10例,全部静脉滴注5～7天为1疗程。应用Ara-C200mg·d-1组和ALL组化疗前不用G-CSF,ALL患者每周加用长春新碱2mg,共2次;强的松60～80mg·d-1,共14天。化疗后WBC<1.0×109/L者加用G-CSF,剂量均为300μg·d-1,皮下注射至WBC3.0×109/L以上。每疗程完成后复查骨髓。结果:16例难治性ANLL的CR率为56.3%,而12例难治性ALL的CR率为8.3%(P<0.01);难治性ANLL患者中Ara-C200mg·d-1组的CR率高于500～1000mg·d-1组(70%∶33%),但无统计学差异(P>0.05)。化疗后WBC0.6×109/L和血小板15.6×109/L的平均持续时间分别为5天和4.3天,Ara-C200mg·d-1组感染发生率明显低于500～1000mg·d-1Ara-C组(58.0%∶85.7%)(P<0.05)。结论:与经典的FLAG方案相比,改良FLAG
BACKGROUND & OBJECTIVE: The FLAG regimen has been used for many years in the treatment of refractory recurrent acute non-lymphocytic leukemia (ANLL). The reported CR rate is mostly 50% -64%. This study explored whether the improved FLAG regimen (reducing the dose of Ara-C in combination with G-CSF prior to chemotherapy) would achieve the same effect and reduce adverse effects. Methods: Totally 16 refractory ANLLs, 12 refractory acute lymphoblastic leukemia (ALL) and 5 recurrent ALL were studied in 33 adult patients with acute leukemia. All cases received fludarabine 30mg · (m2 · d) -1, intravenous drip, 1st to 5th days; Ara-C200mg · d-1 in 18 cases, Ara-C500mg · d-1 in 5 cases, Ara-C1000mg · d-1 in 10 cases, all intravenous drip 5 to 7 days for a course of treatment. Application of Ara-C200mg · d-1 group and ALL group without G-CSF before chemotherapy, ALL patients weekly added vincristine 2mg, a total of 2 times; prednisone 60 ~ 80mg · d-1, a total of 14 days. Chemotherapy after WBC <1.0 × 109 / L plus G-CSF, the dose was 300μg · d-1, subcutaneous injection of WBC3.0 × 109 / L or more. Review the bone marrow after each course is completed. Results: The CR rate of 16 refractory ANLL patients was 56.3%, while the CR rate of 12 refractory ALL patients was 8.3% (P <0.01). CR of Ara-C 200mg · d-1 group Rate was higher than 500 ~ 1000mg · d-1 group (70%: 33%), but no statistical difference (P> 0.05). The average duration of WBC 0.6 × 109 / L and platelet 15.6 × 109 / L after chemotherapy was 5 days and 4.3 days, respectively. The incidence of infection in Ara-C 200 mg · d-1 group was significantly lower than that of 500-1000 mg · d-1Ara- Group C (58.0%: 85.7%) (P <0.05). Conclusion: FLAG is improved compared to the classical FLAG regimen