（m）HAD方案诱导治疗急性单核细胞白血病的疗效及与染色体核型分组关系分析

Analysis of effectiveness and prognostic factors for （m）HAD regimen as induction therapy in acute monocytic leukaemia

目的分析（m）HAD方案诱导治疗急性单核细胞白血病（AMOL）的疗效及染色体核型对预后的影响。方法对79例用（m）HAD方案诱导治疗的AMOL患者临床资料进行回顾性分析。（m）HAD方案具体为高三尖杉酯碱2mg／m^2，第1～7天；阿糖胞苷100mg／m^2，第1～7天，部分患者于第5、6、7天改为1．5g·m^-2·（12h）^-1；柔红霉素40mg／m^2，第1—3天。结果①诱导化疗完全缓解（CR）率79．7％（79例中63例），部分缓解（PR）率6．3％（79例中5例），总有效率86．0％。②对75例患者进行染色体核型分析，正常核型43例，异常核型30例，未见分裂象2例；预后中等组49例，预后差组18例，意义未知组6例。核型正常者CR率及1年、3年总体生存（OS）率明显高于核型异常者（P〈0．05）；但两组在无病生存（DFS）方面差异无统计学意义（P〉0．05）。染色体核型预后中等组患者CR率85．7％，1年、3年OS率分别为75．9％、65．4％，DFS率分别为82．2％、77．9％，均明显好于预后差组（CR率61．1％，1年、3年OS率分别为51．3％、25．6％；1年、3年DFS率分别为66．7％、26．7％）（P〈0．05）。@cox多因素分析显示，染色体核型、巩固治疗疗程数对生存有显著的影响。结论采用（m）HAD方案诱导治疗AMOL患者，CR率高，缓解后巩固治疗是否充分明显影响患者的预后。AMOL患者异常核型发生率和既往报道的急性髓系白血病群体发生率相似，且染色体核型同样与预后密切相关，预后中等组明显优于预后差组。

Objective To analyze the treatment outcome and impact of cytogenetic abnormalities on the response and survival of acute monocytic leukaemia （AMOL） patients received （m）HAD regimen as induction chemotherapy. Methods Seventy-nine AMOL patients were treated with （In）HAD regimen as induction therapy （HHT 2 mg/m^2,d 1 -7; Ara-C 100 mg/m^2,d 1 -7 and increasing to 1.5 g · m^-2 （ 12 h）^-1, d 5 -7 in some patients; DNR40 mg/m^2 ,d 1 -3）. The treatment outcome and prognostic factors were analyzed. Results （1）The complete remission（ CR） rate was 79.7% （63/79） , partial remission （PR） rate was 6.3% （5/79） ,overall rate was 86.0%. （2）The chromosome karyotypes were analyzed in 75 patients, of whom 43 with normal karyotypes （NCR） and 30 abnormal karyotypes （ACR）. For the cytogenetic prognostic groups, 49 patients were intermediate, 18 poor and 6 unknown. The CR, 1-year and 3-year overal survival （OS） rates in NCR group were significantly higher than those in ACR group （ P 〈 0.05） ; but there was no significantly statistical difference in disease free survival （ DFS ） between the two groups （ P 〉 0.05 ）. The CR, 1-year OS ,3-year OS and 1-year DFS and 3-year DFS rates in intermediate prognostic group were significantly higher than those in poor prognostic group （85.7% vs 61.1% , 75.9% vs 51.3% , 65.4% vs 25.6% , 82.2% vs 66.7%, and 77.9% vs 26.7%, respectively） （ P 〈 0.05 ）. （3）Chromosome karyotype and the number of consolidation therapy courses had more important influence on survival in COX analysis. Conclusion （m）HAD regimen as induction chemotherapy for AMOL patients achieves a high CR rate. It has an important influence on survival for the patients to reveive adequate consolidation therapy. The frequency of cytogenetic abnormalities in AMOL is similar to that in other AMLs. The prognosis of AMOL patients with chromosome karyotype in intermediate prognostic group is significantly better than that in poor prognostic group.