以西达本胺联合地西他滨为主的诱导化疗方案治疗伴感染儿童急性髓系白血病3例并文献复习

梁妍; 柴丽娜; 王国旗; 王林莉; 冯晨

doi:10.3969/j.issn.2095-5227.2021.09.021

以西达本胺联合地西他滨为主的诱导化疗方案治疗伴感染儿童急性髓系白血病3例并文献复习

Chidamide plus DCAG regimen in treatment of pediatric acute myeloid leukemia: A report of three cases and literature review

摘要

摘要:
背景儿童期急性髓系白血病(acute myeloid leukemia，AML)复发率高，多重耐药，且传统化疗方案不良反应较大。近年来随着表观遗传学研究的发展，西达本胺成为研究热点。国内外有少量文献报道应用CDCAG方案(西达本胺、地西他滨、阿糖胞苷、阿克拉霉素及粒细胞刺激因子)治疗成人AML收获了较好的疗效，且并发症发生率较低，但目前尚无该方案在儿童中大规模应用的报道。
目的探讨以西达本胺联合地西他滨为主，并阿糖胞苷和聚乙二醇化重组人粒细胞刺激因子(CDCG)的诱导缓解方案对伴感染儿童急性髓系白血病的治疗安全性及有效性。
方法 3例CDCG方案治疗的伴感染AML患儿。病例1：女，10岁，2020年10月23日入院，以颈部淋巴结肿大起病，应用1个疗程DAE方案化疗后出现肺部感染，随后接受2个疗程CDCG方案化疗。病例2：女，12岁，2020年10月21日入院，以反复发热伴咳嗽起病，入院时即存在肺部感染，第1疗程应用DAE方案化疗后肺部感染加重，并出现腹部感染，第2疗程更换为CDCG方案化疗。病例3：女，12岁，2021年2月18日入院，以鼻窦炎、左侧乳突炎起病，接受1个疗程CDCG方案化疗。
结果 3例患儿因合并感染，应用1～3个疗程CDCG方案后复查骨髓形态学或分子生物学均完全缓解（CR），3/4级不良事件为感染及中性粒细胞缺乏伴发热，无其他不良事件。
结论应用西达本胺联合地西他滨为主的诱导化疗方案治疗儿童AML可达到CR，不良事件发生率较其他方案低，文献检索共搜集到2篇文献共108例应用CDCAG方案的患者，其中儿童患者占4.6%，所有病例应用CDCAG方案1～2个疗程后，48.15%获得了CR/CRi。推测该方案可成为治疗伴感染儿童AML的有效手段。

Abstract:
Background Childhood acute myeloid leukemia has high recurrence rate, multiple drug resistance, and the side effects of traditional chemotherapy are serious. In recent years, with the development of epigenetic research, chidamide has become a research hotspot. There are a few reports at home and abroad about the application of CDCAG regimen (citabine, decitabine, cytarabine, clarithromycin and granulocyte stimulating factor) in the treatment of adult AML, which has a good curative effect and low complications. However, there is no report about the large-scale application of CDCAG regimen in children.
Objective To investigate the safety and efficacy of chidamide, decitabine, cytarabine, aclarubicin and PEG-rhG-CSF (CDCG) regimen on acute myeloid leukemia (AML) in children with infection.
Methods Three cases of AML with infection were treated with CDCG regimen. Case 1 was a 10-year-old girl, who was admitted on October 23, 2020. She developed pulmonary infection after one course of chemotherapy with DAE regimen, and then received two courses of chemotherapy with CDCG regimen. Case 2 was a 12-year-old girl, who was admitted on October 21, 2020. She developed recurrent fever and cough, and had pulmonary infection at the time of admission. After the first course of chemotherapy with DAE regimen, the pulmonary infection aggravated and abdominal infection occurred. The second course of chemotherapy was replaced with CDCG regimen. Case 3 was a 12-year-old girl, who was admitted on February 18, 2021. She developed sinusitis and left mastoiditis, and received a course of CDCG chemotherapy.
Results After 1-3 courses of CDCG regimen, bone marrow morphology and molecular biology results showed complete remission. Grade 3/4 adverse events were infection and neutropenia with fever. No other adverse event was found.
Conclusion The application of CDCG regimen in the treatment of childhood AML with infection can achieve CR, and the incidence of adverse events is lower than that of other regimens. A total of 108 cases with CDCAG regimen are collected by literature search, and 48.15% of them receive CR/CRi after 1-2 courses of CDCAG regimen, which suggests that this regimen is an effective method for the treatment of AML in children with infection.

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