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ASH 2014：中高危MDS和CMML的临床难题仍待探索

2014-12-22 CMT 中国医学论坛报

ASH血液病白血病
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北京协和医院血液科庄俊玲副教授应记者邀请对当地时间12月9日上午ASH2014公布的一项关于中高危骨髓异常增生综合征(MDS)和慢性粒单核细胞白血病">白血病(CMML)的最新揭晓临床研究(LBA)给予了解读。 Sekeres M.A.等代表北美协作组多家单位，将SWOG S1117方案的初步结果(摘要号：LBA-5)在今年ASH会议上汇报。这项Ⅱ期随机临床试验比较了去甲基化药物阿扎胞

北京协和医院血液科庄俊玲副教授应记者邀请对当地时间12月9日上午ASH2014公布的一项关于中高危骨髓异常增生综合征(MDS)和慢性粒单核细胞白血病">白血病(CMML)的最新揭晓临床研究(LBA)给予了解读。

Sekeres M.A.等代表北美协作组多家单位，将SWOG S1117方案的初步结果(摘要号：LBA-5)在今年ASH会议上汇报。这项Ⅱ期随机临床试验比较了去甲基化药物阿扎胞苷(AZA)联合来那度胺(LEN)或组蛋白去乙酰化酶抑制剂(HDACI)伏林司他(VOR)与阿扎胞苷单药治疗中高危骨髓异常增生综合征(MDS)和慢性粒单核细胞白血病(CMML)患者的疗效和安全性。研究共入组282例患者，中位随访9个月，中位用药时间为23周，各组近似。全部队列的总有效率(ORR)为33%，AZA组36%，AZA+LEN组37%，AZA+VOR组22%(p=0.07)。所有患者中位无复发时间(RFS)为7个月。不良反应包括粒细胞减少，消化道反应和感染在各组类似。

北京协和医院血液科庄俊玲教授：中高危MDS和CMML，尤其是伴有原始细胞增多的患者，向白血病转化的发生率高，常规化疗效果差，生存期缩短，是临床面对的难题。异基因造血干细胞移植是唯一可能治愈此类疾患的方法，近几年研究发现去甲基化药物也有一定疗效，但联合HDACI或免疫调剂剂(IMiD)是否具有协同作用是本研究所回答的问题。研究结果发现不管是ORR还是RFS在单药或联合用药组均无显著差异， AZA+LEN治疗后中性粒细胞升高虽然显著好于其他两组，但总体疗效并未改善。所有患者用药7个月左右出现疾病进展，少数接受异基因干细胞移植，再次说明疾病预后不佳。本研究的阴性结果尚不能完全否定联合用药的疗效，可能需要随访更长时间才能得出确切结论。

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  1. [GetPortalCommentsPageByObjectIdResponse(id=1842782, encodeId=098d1842e82ff, content=<a href='/topic/show?id=9f061142249' target=_blank style='color:#2F92EE;'>#MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11422, encryptionId=9f061142249, topicName=MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Sat Dec 27 20:17:00 CST 2014, time=2014-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1685406, encodeId=cf3e16854066d, content=<a href='/topic/show?id=7c5c490342' target=_blank style='color:#2F92EE;'>#CMML#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4903, encryptionId=7c5c490342, topicName=CMML)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c7c28182882, createdName=kkunny, createdTime=Tue Jul 28 06:17:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1822234, encodeId=d1571822234fa, content=<a href='/topic/show?id=c6071022467a' target=_blank style='color:#2F92EE;'>#高危MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102246, encryptionId=c6071022467a, topicName=高危MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Mar 02 23:17:00 CST 2015, time=2015-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17551, encodeId=2e111e55156, content=超赞，好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Wed Mar 04 10:47:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301151, encodeId=060f130115144, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Dec 24 00:17:00 CST 2014, time=2014-12-24, status=1, ipAttribution=)]
    2014-12-27 d830372

    #MDS#

    0

  2. [GetPortalCommentsPageByObjectIdResponse(id=1842782, encodeId=098d1842e82ff, content=<a href='/topic/show?id=9f061142249' target=_blank style='color:#2F92EE;'>#MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11422, encryptionId=9f061142249, topicName=MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Sat Dec 27 20:17:00 CST 2014, time=2014-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1685406, encodeId=cf3e16854066d, content=<a href='/topic/show?id=7c5c490342' target=_blank style='color:#2F92EE;'>#CMML#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4903, encryptionId=7c5c490342, topicName=CMML)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c7c28182882, createdName=kkunny, createdTime=Tue Jul 28 06:17:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1822234, encodeId=d1571822234fa, content=<a href='/topic/show?id=c6071022467a' target=_blank style='color:#2F92EE;'>#高危MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102246, encryptionId=c6071022467a, topicName=高危MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Mar 02 23:17:00 CST 2015, time=2015-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17551, encodeId=2e111e55156, content=超赞，好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Wed Mar 04 10:47:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301151, encodeId=060f130115144, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Dec 24 00:17:00 CST 2014, time=2014-12-24, status=1, ipAttribution=)]
    2015-07-28 kkunny

    #CMML#

    0

  3. [GetPortalCommentsPageByObjectIdResponse(id=1842782, encodeId=098d1842e82ff, content=<a href='/topic/show?id=9f061142249' target=_blank style='color:#2F92EE;'>#MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11422, encryptionId=9f061142249, topicName=MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Sat Dec 27 20:17:00 CST 2014, time=2014-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1685406, encodeId=cf3e16854066d, content=<a href='/topic/show?id=7c5c490342' target=_blank style='color:#2F92EE;'>#CMML#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4903, encryptionId=7c5c490342, topicName=CMML)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c7c28182882, createdName=kkunny, createdTime=Tue Jul 28 06:17:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1822234, encodeId=d1571822234fa, content=<a href='/topic/show?id=c6071022467a' target=_blank style='color:#2F92EE;'>#高危MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102246, encryptionId=c6071022467a, topicName=高危MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Mar 02 23:17:00 CST 2015, time=2015-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17551, encodeId=2e111e55156, content=超赞，好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Wed Mar 04 10:47:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301151, encodeId=060f130115144, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Dec 24 00:17:00 CST 2014, time=2014-12-24, status=1, ipAttribution=)]
    2015-03-02 hbwxf

    #高危MDS#

    0

  4. [GetPortalCommentsPageByObjectIdResponse(id=1842782, encodeId=098d1842e82ff, content=<a href='/topic/show?id=9f061142249' target=_blank style='color:#2F92EE;'>#MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11422, encryptionId=9f061142249, topicName=MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Sat Dec 27 20:17:00 CST 2014, time=2014-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1685406, encodeId=cf3e16854066d, content=<a href='/topic/show?id=7c5c490342' target=_blank style='color:#2F92EE;'>#CMML#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4903, encryptionId=7c5c490342, topicName=CMML)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c7c28182882, createdName=kkunny, createdTime=Tue Jul 28 06:17:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1822234, encodeId=d1571822234fa, content=<a href='/topic/show?id=c6071022467a' target=_blank style='color:#2F92EE;'>#高危MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102246, encryptionId=c6071022467a, topicName=高危MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Mar 02 23:17:00 CST 2015, time=2015-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17551, encodeId=2e111e55156, content=超赞，好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Wed Mar 04 10:47:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301151, encodeId=060f130115144, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Dec 24 00:17:00 CST 2014, time=2014-12-24, status=1, ipAttribution=)]
    2015-03-04 xiaoai5777

    超赞，好文章

    0

  5. [GetPortalCommentsPageByObjectIdResponse(id=1842782, encodeId=098d1842e82ff, content=<a href='/topic/show?id=9f061142249' target=_blank style='color:#2F92EE;'>#MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=42, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=11422, encryptionId=9f061142249, topicName=MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=80a244, createdName=d830372, createdTime=Sat Dec 27 20:17:00 CST 2014, time=2014-12-27, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1685406, encodeId=cf3e16854066d, content=<a href='/topic/show?id=7c5c490342' target=_blank style='color:#2F92EE;'>#CMML#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=30, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=4903, encryptionId=7c5c490342, topicName=CMML)], attachment=null, authenticateStatus=null, createdAvatar=null, createdBy=5c7c28182882, createdName=kkunny, createdTime=Tue Jul 28 06:17:00 CST 2015, time=2015-07-28, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1822234, encodeId=d1571822234fa, content=<a href='/topic/show?id=c6071022467a' target=_blank style='color:#2F92EE;'>#高危MDS#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=38, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=102246, encryptionId=c6071022467a, topicName=高危MDS)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=55ce62, createdName=hbwxf, createdTime=Mon Mar 02 23:17:00 CST 2015, time=2015-03-02, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=17551, encodeId=2e111e55156, content=超赞，好文章, beContent=null, objectType=article, channel=null, level=null, likeNumber=123, replyNumber=0, topicName=null, topicId=null, topicList=[], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=36a81612921, createdName=xiaoai5777, createdTime=Wed Mar 04 10:47:00 CST 2015, time=2015-03-04, status=1, ipAttribution=), GetPortalCommentsPageByObjectIdResponse(id=1301151, encodeId=060f130115144, content=<a href='/topic/show?id=38e32852fe' target=_blank style='color:#2F92EE;'>#ASH#</a>, beContent=null, objectType=article, channel=null, level=null, likeNumber=23, replyNumber=0, topicName=null, topicId=null, topicList=[TopicDto(id=2852, encryptionId=38e32852fe, topicName=ASH)], attachment=null, authenticateStatus=null, createdAvatar=, createdBy=39a0295, createdName=kksonne, createdTime=Wed Dec 24 00:17:00 CST 2014, time=2014-12-24, status=1, ipAttribution=)]
    2014-12-24 kksonne

    #ASH#

    0

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