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目的分析地西他滨治疗骨髓增生异常综合征(MDS)患者的临床疗效与不良反应,并探讨治疗后P15基因的甲基化水平变化。方法对广东省人民医院血液科2009年11月至2012年3月接受地西他滨治疗的31例MDS患者[难治性血细胞减少伴多系病态造血(RCMD)9例,难治性贫血伴有原始细胞增多I(RAEB-Ⅰ)11例,RAEB-Ⅱ7例,慢性粒单核细胞白血病(CMML)4例]进行回顾性分析,其中28例接受5 d方案,3例接受3 d方案。从中抽取7例RAEB-Ⅰ及RAEB-Ⅱ患者,使用实时荧光定量聚合酶链式反应(PCR)连续监测其P15基因甲基化水平的变化。结果在可评估的28例患者中,完全缓解(CR)3例,骨髓完全缓解伴血液学改善(m CR+HI)5例,骨髓完全缓解(m CR)7例,单纯血液学改善(HI)3例,疾病稳定(SD)9例,疾病进展1例,CR率10.7%,总有效率(CR+m CR+HI)64.3%,2年生存率为46.4%。经地西他滨治疗后,患者P15基因明显降低,且用药后第1周下降幅度最大,达20%~60%。结论地西他滨治疗MDS患者具有一定疗效,不良事件具有可控性,且治疗后P15基因明显下降。
Objective To analyze the clinical efficacy and adverse reactions of decitabine in the treatment of patients with myelodysplastic syndrome (MDS) and to explore the changes of the methylation level of P15 gene after treatment. Methods Thirty-one patients with MDS treated with decitabine in Department of Hematology, Guangdong Provincial People’s Hospital from November 2009 to March 2012 were treated with refractory cytopenia (RCMD), 9 with refractory anemia There were 11 cases of RAEB-Ⅰ, 7 cases of RAEB-Ⅱ and 4 cases of chronic myelomonocytic leukemia (CMML). Of these, 28 cases received 5 days and 3 cases received 3 days. Seven patients with RAEB-Ⅰ and RAEB-Ⅱ were selected and their methylation levels of P15 gene were continuously monitored by real-time fluorescence quantitative polymerase chain reaction (PCR). Results Among the 28 evaluable patients, there were 3 cases of complete remission (CR), 5 cases of complete remission with hematological improvement (m CR + HI), 7 cases of complete remission of bone marrow (m CR), 7 cases of simple hematological improvement ), 3 cases of stable disease (SD), 9 cases of disease progression, 1 case of disease progression, CR rate of 10.7%, total effective rate (CR + m CR + HI) 64.3% and 2-year survival rate of 46.4%. After decitabine treatment, P15 gene was significantly reduced, and the largest decline in the first week after treatment, up to 20% to 60%. Conclusion Decitabine treatment of patients with MDS has a certain effect, controllable adverse events, and P15 gene was significantly decreased after treatment.