标准剂量去甲氧柔红霉素联合阿糖胞苷持续静脉点滴治疗急性髓系白血病

Standard-dose of Idarubicin in Combination with Continuous Infusion of Cytarabine as Induction Therapy in Patients with Acute Myeloid Leukaemia

本研究旨在探讨标准剂量的去甲氧柔红霉素(IDA)联合阿糖胞苷(Ara-C)持续静脉点滴治疗急性髓细胞白血病(AML)的疗效和不良反应。38例AML患者(初治AML30例,难治、复发AML8例)均在治疗前进行染色体核型分析,染色体异常核型15例,复杂染色体异常4例。诱导方案为第1-3天IDA12mg/(m2.d),第1-7天Ara-C100mg/(m2.d),持续静脉点滴。结果显示:1个疗程总有效率为89.5%(34/38),完全缓解(CR)率84.2%(32/38),其中初治AML的CR率为90.0%(27/30),复发、难治AML的CR率为62.5%(5/8),4例复杂染色体异常患者均达细胞遗传学缓解。6例经上述治疗后疾病复发,3例早期复发,3例晚期复发。总生存期中位时间>22月,无病生存中位时间>16月。化疗的不良反应主要为骨髓抑制和粒细胞缺乏所致感染,未见严重的非造血系统不良反应。结论:标准剂量的IDA联合Ara-C24小时持续静脉点滴为初治、复发、难治AML的高效、安全的方案,此方案为患者进行造血干细胞移植创造了时机。

The objective of this study was to investigate the efficacy and toxicity of standard-dose idarubicin in combination with continuous infusion of cytarabine as induction therapy in patients with acute myeloid leukemia （AML）. A total of 38 AML patients were enrolled, including 30 new diagnosed patients, 8 relapsed and refractory patients. Cytogenetic analysis was performed in all patients, 15 patients had cytogenetic aberrations including 4 complex abnormalities. All patients were treated with standard-dose idarubicin [12 mg/（ m2·d）, days 1 to 3] and continous infusion of cytarabine [100 rag/（ m^2·d）, days 1 to 7]. The results showed that after one course of induction therapy, the overall response rate was 89.5 % （34/38）, and 32 out of 38 （84.2%） patients achieved complete remission （CR）, including 27 of 30 （90.0%） new diagnosed AML patients, 5 （62.5%） refractory and relapsed AML patients, all 4 patients with complex cytogenetic aberrations achieved cytogenetic CR. Out of 6 relapsed patients 2 showed as extrameduallary relapse, 4 showed as bone marrow relapse. The median survival duration was 〉 22 months and median disease-free survival time was 〉 16 months. Myelosuppression and infections due to neutropenia were the most frequent adverse effects, severe nonhematologic toxicity and the early death were not observed in the patients. It is concluded that standard-dose of idarubicin combined with continuous infusions of cytarabine as the induction therapy is highly effective and well tolerated approach in patients with AML, this regimen provides an opportune moment for hematopoietic stem cell transplantation.