循环应用CAG和IA方案治疗老年急性髓性白血病的临床观察

Cyclic application of CAG and IA regimens in treatment of elderly patients with acute myeloid leukemia

目的:观察循环应用CAG、IA方案治疗老年初治急性髓性白血病(AML)的疗效及不良反应。方法:25例老年初治AML患者分为CAG、IA循环化疗组(Ⅰ组)以及常规方案化疗组(Ⅱ组),Ⅰ组10例患者给予CAG方案治疗,如达不到完全缓解原方案再次治疗,完全缓解后给予IA方案化疗,间歇1个月后再循环应用CAG、IA方案化疗;Ⅱ组15例患者予常规柔红霉素(DNR)+阿糖胞苷(DA)或米托蒽醌+阿糖胞苷(MA)方案化疗,完全缓解后应用DA、MA、HA和IA等方案化疗。结果:Ⅰ组2个周期完全缓解率为60%(6/10),总有效率达到80%(8/10),而Ⅱ组2个周期的完全缓解率仅为26.7%(4/15),总有效率为53.3%(8/15);Ⅰ组无化疗相关死亡病例,Ⅱ组化疗相关死亡率为20%。结论:循环应用CAG、IA方案治疗老年初治AML患者较传统常规化疗方案治疗具有完全缓解率及2年生存率高,毒副反应小的优点。

OBJECTIVE：To observe the efficacy and side effect of cyclic application of CAG and IA regimens in the treatment of newly diagnosed acute myeloid leukemia （AML） in elderly patients. METHODS：Twenty-five newly diagnosed AML elderly patients were divided into group Ⅰ and group Ⅱ. The patients of group Ⅰ were treated by the CAG＋ⅠA regimen and the others were treated by the conventional regimen. Ten patients of group Ⅰ applied arabinosylcytosine and aclarubicin combined with granulocyte colony-stimulating factor,and continued to apply idarubicin and rabinosylcytosine when they were complete remission （CR）. Then after one month,they began to apply CAG and IA regimen in circles. If someone did not reach the complete remission,he continued the second course with the same CAG regimen. Fifteen patients of group Ⅱ applied conventional regimen （daunorubicin and arabinosylcytosine/mitoxantrone and arabinosylcytosine）,and continued the chemotherapy with DA,MA,HA,IA regimen after CR. RESULTS：The CR rate of group Ⅰ was 60%（6/10） after two courses,and the total response rate reached to 80%（8/10）. The CR rate of group Ⅱ was only 26.7%（4/15） after two courses,and the total response rate was 53.3%（8/15）. The chemotherapy-related mortality rate of group Ⅱ was 20% when it was zero in group Ⅰ. CONCLUSION：Not only less toxicity,but also higher CR rate and 2-year disease-free survival rate are the advantages of cyclic application of CAG and IA regimens in the treatment of newly diagnosed AML in elderly patients.