HAA方案诱导治疗成人初发急性髓系白血病150例疗效观察

The efficacy and safety of HAA regimen as induction chemotherapy in 150 newly diagnosed acute myeloid leukemia

目的 观察高三尖杉酯碱（HHT）、阿糖胞苷（Ara-C）、阿克拉霉素（Acla）三药联合（HAA）方案治疗成人初发急性髓系白血病（AML）的疗效与安全性.方法 对1999年5月至2008年6月收治的150例初发AML患者以HAA方案诱导治疗,统计完全缓解（CR）率,并采用Cox生存分析方法评估患者的无复发生存（RFS）时间.结果 150例患者CR率为81%,其中1个疗程后CR率为68%.除外5例早期死亡,9例失访,136例患者中位随访时间16.5（1.5～100.5）个月,3年预计总生存（OS）率为45%.对于达到CR的患者,3年预计RFS率为52%.按FAB分型分组,急性粒-单核细胞白血病（M4）/急性单核细胞白血病（M5）组CR率为71%,其CR患者的3年预计RFS率为62%,急性粒细胞白血病未分化型（M1）/急性粒细胞白血病部分分化型（M2）组CR率为92%,CR患者的3年预计RFS率为47%.按染色体核型分组,低危、中危与高危组的CR率分别为97%、84%和38%,其中低危组3年OS率为59%,中危组为45%,高危组13%.结论 HAA方案可作为成人初发AML患者的首选方案.1～2个疗程后可获得较高的CR率和RFS率,且毒副作用可耐受.

Objective To explore the efficacy and safety of HAA regimen （homoharringtonine,cytarabine and aclarubicin） in the treatment of 150 newly diagnosed adult acute myeloid leukemia （AML）.Methods All patients entered the study from May 1999 to June 2008 were treated with HAA regimen. Coxsurvival analysis was used to estimate the survival rate and differences between M1/M2 and M4/M5 were compared with 2-sided log-rank test. Results Out of the 150 patients, 121 （81%） achieved complete remission （CR）. After the first course, CR rate was 68%. The CR rates of 97%, 84% and 38% were achieved in patients with favorable, intermediate and unfavorable cytogenetics, respectively. For the patients with CR, the median follow-up time was 16.5 （ 1.5-100.5 ） months, and the estimated 3-year survival rate was 45%. The estimated 3-year relapse free survival rate was 52% for the 121 patients with CR.Conclusions HAA regimen may be an efficacious and safe regimen with a good toleration in the induction therapy for newly diagnosed AML, and a high CR rate could be achieved with only one or two courses.