标准诱导化疗与粒细胞集落刺激因子预激序贯双诱导治疗原发性初治急性髓细胞白血病

Treating newiy diagnosed de novo acute myeiocytic leukemia patients with sequential dual induction chemotherapy:standard induction chemotherapy combined with granulocyte colony-stimulating factor priming chemotherapy

目的观察粒细胞集落刺激因子(G-CSF)预激序贯双诱导治疗原发性初治急性髓细胞白血病(AML)的疗效和安全性,并与标准诱导化疗方案进行比较。方法将接受标准诱导化疗1个疗程的AML患者分为治疗组和对照组,治疗组接受G-CSF预激序贯双诱导治疗,对照组再接受第2个疗程标准诱导化疗。结果治疗组和对照组患者各18例,年龄分别为(38．3±13．8)和(40．7±13．1)岁。治疗组的完全缓解(CR)率和总反应(CR+部分缓解)率分别为72%和83%,显著高于对照组的33%和50%(P=0．019和0．034)。治疗组达到CR的时间为(17．3±4．7)d,显著短于对照组的(20．9±3．7)d(P=0．04)。治疗中最常见的不良反应为感染,治疗组的肺部感染率为39%,显著低于对照组的72%(P=0．044)。对照组发生严重感染和出血并发症各1例。结论标准诱导化疗与G-CSF预激序贯双诱导治疗原发性初治AML有效且安全。

Objective To observe the efficacy and safety of dual induction chemotherapy regimen in treating patients with newly diagnosed de novo acute myelocytic leukemia（AMID and compare with those of the standard induction chemotherapy. Methods Standard.chemotherapy followed by either granulocyte colony-stimulating factor （G-CSF） regimen（dual induction group） or standard chemotherapy again（control group） was administered to patients with newly diagnosed de novo AML. Clinical manifestations, blood count, blood biochemical parameters and bone marrow smears were measured during the courses. Results Eighteen patients were enrolled in each group, the mean age was（38, 3 ± 13, 8） years in dual induction group and（40.7 ± 13.1） years in the control group, Complete remission（CR） rates were 72% vs 33% and overall response rates were 83% vs 50% respectively, with significant differences（P = 0. 019 nad 0. 034 respectively）. The periods to attain CR were（17.3 ± 4.7） d vs（20.9 ± 3.7） d from the ends of the treatment, were statistically significant （P = 0.04）. Infections, usually of respiratory tract, were the most common side effect in both groups. The difference in the incidences of respiratory tract infections between the two groups was significant（P = 0. 044）, Severe life-threatening complications as septicemia and hemorrhage occurred in the control group only, Conclusions Sequential dual induction chemotherapy regimen is both effective and well tolerated in patients with newly diagnosed de novo AML. （Shanghai Med J, 2007, 30：165-167）