MT与DA方案治疗初治急性单核细胞性白血病的疗效比较

Comparison of MT and DA regimens on initial treatment to acute monocytic leukemia

目的 比较MT方案（米托蒽醌联合替尼泊苷）和DA方案（柔红霉素联合阿糖胞苷）治疗初治急性单核细胞性白血病的疗效及患者不良反应.方法 将初治急性单核细胞性白血病患者40例随机（单纯随机抽样法）分成两组,MT组23例、DA组17例,分别采用MT、DA方案诱导缓解,比较两组的临床疗效及患者不良反应.结果 MT组、DA组第一次化疗完全缓解率分别为65%（15/23）、18%（3/17）,总完全缓解率为83%（19/23）、47%（8/17）,有效率分别为91%（21/23）、59%（10/17）,两组差异均有统计学意义（P〈0.05）.两组均出现明显的造血功能抑制,两组间白细胞最低点、白细胞〈1×10^9/L的持续时间差异无统计学意义（P〉0.05）,但MT组的白细胞最低点出现时间、白细胞〈1×10^9/L的开始、结束时间均较迟,两组差异有统计学意义（P〈0.01）.结论 MT方案治疗初治急性单核细胞性白血病完全缓解率、有效率均明显优于DA方案,方案较简单、有效,可作为初治急性单核细胞性白血病诱导缓解的较佳方案.两组骨髓抑制程度相当,但MT组骨髓抑制发生时间较DA组迟,治疗同时须注意适时加强抗感染、支持治疗.

Objective To compare the therapeutic and adverse effects of MT regimen （mitoxantrone plus teniposide） and DA regimen （daunorubicin plus cytarabine） on initial treatment to acute monocytic leukemia. Methods 40 patients with initial treatment to acute monocytic leukemia were randomly divided into MT group（n=23） and DA group（n=17）. All patients were treated with MT or DA regimen. The result and adverse effects of the two regimens were compared. Results Complete remission（CR） rate in the first course chemotherapy in MT and DA regimen was 65 % and 18 %, respectively. The total CR rate in MT and DA regimen was 83 % and 47 % respectively. The total effective rate was 92 % and 59 %, respectively. Significant differences were found. Severe myelosuppression occurred in both groups. The counts of wbc nadir and the durations of wbc less than 1×10^9/L were not significantly different in two group. The time points of wbc nadir, the start and end time points of wbc less than 1×10^9/L were significantly later in MT group than in DA group. Conclusion MT regimen is significant better than DA regimen in inducing remission in initial treatment acute monocytic leukemia, and it is a good choice for inducing remission strategy. The degrees of myelosuppression in two groups are similar. But the occurrent time of myelosuppression is later in MT group than in DA group. The great attention should be paid to anti-infection and support therapy at time properly.