Clinical Observation Of DAC、AS₂O₃ Plus CAG Chemotherapy Bridging Micro-transplant Regimen On Patient With Myelodysplastic Syndrome

Objective:To observe the recent efficacy and side effects of DAC、AS2O3 combined with preconvention chemotherapy,and bridging close peripheral blood stem cell infusion in the treatment of MDS in average and high risk.Methods:From September 2015 to December 2016,Guangdong Provincial Hospital of Hematology,the application of this study of six patients with prospective study of the study.Six patients with disease diagnosis included MDS、MDS/MPD、MDS/AML。Specific treatment for the program included ①DAC 25mg/d,ivd,qd,dl~5:AS2O310mg/d,qd,ivd,dl~5;②Ara-C10mg/m2H,q12h,d6~12;ACA 20mg/d,ivd,d6、8、10.③48 hours after chemotherapy infusionclose peripheral blood mononuclear cells 1-2×108/kg.28 days for a course of treatment.1.The changes of peripheral blood cells were observed every 7 days after treatment and after treatment;The morphological changes of bone marrow cells and the proportion of primordial cells were observed before and after treatment;And the change of transfusion interval before and after treatment also was observed.At last according to the revised standard of IWG2006 about MDS,the curative effect of this study was evaluated.2.To Observe whether the treatment of patients with bone marrow suppression,infection,bleeding,Heart damage、liver and kidney damage and other adverse reactions,and Analyzed the safety of the treatment regimen.Result:The total response rate of treatment in 6 patients was achieved 66.7%,2 patients achieved CR,1 patient achieved mCR without HI,1 patient achieved mCR with HI,1 patient achieved PD.1 patient got treatment failure(died of perianal infection).The follow-up period ended March 31,2017,2 patients progressed to acute leukemia.The part of hematological improvement:3 of the 6 patients had different levels of peripheral blood improvement after treatment.3 patients were relieved by blood transfusion and 1 patient extended blood transfusion time.The OS was 12 moths(1-14moths).The main adverse reactions were myelosuppression、infection and Severe arrhythmia.Myelosuppression is the most common,the incidence of 3-4 level anemia,neutropenia and thrombocytopenia were 41.7%、83.3%、75%.There were seven treatments for the use of antibiotics in the course of treatment,Which has three courses of pulmonary infection and a course of treatment perianal infection and three courses have no obvious infection.There are 3 courses of severe arrhythmia and a course of treatment of mild liver dysfunction,but it return to normal after strengthen the liver.And none of the patients had GVHD.Conclusion:the new regimen has a certain effect on the patients with Relatively high risk group MDS,MDS/MPD and MDS/AML.The regimen can prolong the disease to leukemia conversion time,Improve the quality of life of patients,Peripheral blood stem cell infusion can shorten the time of bone marrow suppression after chemotherapy and Disease achieved CR can also bridge allo-HSCT.The adverse reactions are mainly myelosuppression and granulocyte deficiency fever.But the treatment process is relatively safe.We can not perform statistical analysis because of the number of cases and other issues,so we still need further study to observe its clinical efficacy and safety.