以HAA方案诱导治疗成人初发急性髓系白血病疗效观察

HAA regimen as induction chemotherapy for newly diagnosed acute myelogenous leukemia

目的对1999年5月至2004年12月收治的80例成人初发急性髓系白血病（AML）患者，以HAA（高三尖杉酯碱、阿糖胞苷、阿柔比星）方案进行诱导治疗，探讨该方案治疗成人初发AML患者的有效性和安全性。方法初发AML患者80例以HAA方案诱导治疗，计算完全缓解（ca）率，并采用Kaplan—Meier方法评估患者的无复发生存（RFS）率，组间患者RFS差异用Log—rank检验。结果80例患者CR率为81％，其中1个疗程CR率为75％。除外4例早期死亡患者，76例患者中位随访时间为26（2—69）个月，3年预计总生存（OS）率为51％。对于达到CR的患者，3年预计RFS率为53％。按FAB分型分组，M5组CR率为74％，其CR患者的3年预计RFS率为75％，M1／M2组CR率为87％，其CR患者的3年预计RFS率为37％。按染色体核型分组，低危组、中危组与高危组的CR率分别为100％，83％和20％，其中低危组3年OS率为76％，中危组为50％，高危组的中位生存时间仅有6个月。结论HAA方案可以作为成人初发AML患者的首选方案。通过1～2个疗程的化疗，能够获得比较高的CR率以及RFS率。

Objective To analyse the outcome of newly diagnosed adult acute myeloid leukemia （AML） patients treated with HAA （ homoharringtonine, cytarabine and aclarubicin） regimen and explore the efficacy and safety of this regimen. Methods Eighty patients were treated with HAA regimen. The complete remission （CR） rate was observed. Kaplan-Meier method was used to estimate relapse free survival（RFS） rate and the differences were compared with 2-sided log-rank test. Results Of the 80 patients, 65 （81%） attained CR and the CR rate after the first course of induction was 75%. For the CR patients, the median follow-up was 26 （2 -69） months, and the estimated 3-year overall survival（OS） rate was 51% and the estimated 3-year RFS was 53%. For the AML-M5 and AML-M1/M2 patients the CR rate was 74% and 87% and 3 year RFS of CR patients was 75% and 37% , respectively. The CR rate of 100% , 83% and 20% was achieved in patients with favorable, intermediate and unfavorable cytogenetics, respectively. The 3 year OS for favarable and intermediate group was 76% and 50% respectively. The median survival time of unfavorable group was only 6 months. Conclusion HAA regimen is a safe, efficacious, and well-tolerable induction therapy for newly diagnosed AML.