老年急性髓系白血病个体化治疗探讨

Individual treatment of acute myelogenous leukemia in elderly patients

目的：探讨老年急性髓系白血病（AML）个体化治疗方案。方法：对我院1994～2005年收治老年AML患者（≥60岁）77例进行回顾性分析。根据化疗剂量将患者分为A（亚标准剂量）、B（减量化疗）及C（支持化疗）3组，并对3组的临床特征和治疗效果进行比较。结果：可评价患者A组45例，B组9例，C组9例。A组CR率高于B组（P〈0．05），分别为53.3％和44．4％；平均生存期显著延长（P〈0．05），分别为258、195d。但白细胞化疗后最低值A组要明显低于B组（分别为0．8×10^9／L，4．5×10^9／L），骨髓抑制时间明显延长（分别为19，13d），不良反应发生率明显增高（分别为97．8％，77．8％）。C组患者平均生存期231d，生存期与其他2组均差异无统计学意义（均P〉0．05），但平均住院日明显缩短（P〈0．05）。结论：老年AML对化疗反应差，缓解率低，生存期短，治疗方案宜个体化。

Objective：To explore the best treatment strategy in older patients with acute myelogenous leukemia. Method：77 patients aged≥60 years with acute leukemia from 1994 to 2005 were analyzed retrospectvely. The patients are divided into substandard-dose regimen group（Group A）, palliative regimen group（Group B） and sup- portive care group（Group C） according to the dosage of chemotherapy. The clinical characteristics and treatment results of the patients are compared. Result：There are 45, 9 and 9 case in group A, B, C respectively. The complete remission（CR） of group A is remarkably higher than group B, 53.3% and 44.4% respectively. The mean survival time of group A is longer than group B, 258 and 195 days respectively. But the lowest white blood cell count after chemotherapy, bone marrow suppression time and the rate of side effect of group A is higher than that of group B （ P〈0.05）. The mean survival time of group C is 231 days, there is no significant difference when compared with the other two groups. But the duration of hospitalization is obviously reduced. Conclusion： The response of acute myelogenous leukemia of the elderly people to chemotherapy is relatively poor, and they have a lower CR rate and shorter overall survival time. The patients should be treated individually.