预激方案CAG治疗老年初治急性髓性细胞白血病的疗效

Therapeutic effect of priming induction regimen of CAG for newly diagnosed acute myeloid leukemia in elderly patients

目的:评价含粒细胞集落刺激因子(granulocyte colony-stimulating factor,G-CSF)的CAG方案治疗老年初治急性髓性细胞白血病(AML)的疗效及不良反应。方法:75例老年初治AML分为CAG预激治疗组及常规方案化疗组,34例患者予以CAG预激方案治疗,41例患者予以常规吡柔比星+阿糖胞苷(TA)或高三尖杉脂碱+阿糖胞苷(HA)方案化疗,所有患者在第1疗程后间歇14d左右进行第2个疗程。结果:CAG预激治疗组2疗程完全缓解率为67.6%,总有效率达到82.4%,而常规化疗组2疗程的完全缓解率仅为39.0%,总有效率为56.1%;有预后差染色体核型的患者化疗疗效差,CAG预激治疗组的3年无病生存时间长于常规化疗组;CAG预激组除肌肉酸痛发生率较高外,其他血液系统及非血液系统的毒性和不良反应明显少于常规化疗组。结论:CAG预激方案治疗初治AML患者较之传统常规治疗具有化疗强度温和、敏感性好、完全缓解率及有效率高、毒副作用小,可以减少粒细胞缺乏恢复时间、减少合并感染率及增加幼稚细胞对化疗药物的敏感性等优点,推荐使用。

Objective To evaluate the clinical efficacy and toxicity of priming induction regimen of CAG for newly diagnosed acute myeloid leukemia （AML） in elderly patients. Methods Seventy-five patients with newly diagnosed AML were divided into 2 groups： 34 were treated with priming induction regimen CAG and the other 41 were treated with 2 classic routine chemotherapy regimens including pirarubicin＋cytarabin （ TA ） and homoharringtonine ＋ cytarabine （ HA ）. All patients had a 14 day interval between the 2 courses of chemotherapy. Results The complete remission rate after 2 courses of induction therapy in patients with the priming induction regimen CAG and the total efficacy rate was significantly higher than that of the routine chemotherapy patients （67. 6% vs. 39 % ; 82.4 % vs. 56.1% ）. Patients with unfavorable karyotypes had poor chemotherapy efficacy. The 3-year disease-free-survival（DFS） time was longer in patients with AML treated with priming induction regimen CAG than in patients treated with 2 classic routine chemotherapy regimens. Except for the muscular soreness, the hematological and non-hematological side effects in the CAG priming induction group were significantly fewer than those in the routine chemotherapy group. Conclusion The priming induction regimen of CAG has a significantly higher complete remission rate and an efficacy rate, fewer side effects, milder chemotherapy intensity and is more sensitive to chemotherapeutic drugs than those of the routine chemotherapy. It can shorten the duration of agranulocytosis and decrease infectious complications and increase the sensitivity of leukemia blast cells to chemotherapeutic drugs.