IA方案诱导治疗急性髓系白血病的临床研究

Clinical research of IA regimen as induction chemotherapy for acute myeloid leukemia

目的探讨去甲氧柔红霉素（IDA）联合阿糖胞苷（Ara—C）组成的IA方案诱导治疗不同预后组急性髓系自血病（AML）患者的临床疗效及安全性。方法回顾性分析60例初治AML患者应用IA方案治疗1个疗程后的临床资料。结果预后良好组12例，完全缓解（CR）率83．3％（10／12），部分缓解（PR）率16．7％（2／12），总有效（OR）率100％（12／12）；预后中等组26例，CR率73．1％（19／26），PR率19．2％（5／26），OR率92.3％（24／26）；预后不良组22例，CR率59．1％（13／22），PR率13．6％（3／22），OR率72．7％（15／22）；三组患者OR率比较差异无统计学意义（P=0．113）。随访2年，预后良好组无复发生存（RFS）率100．0％，预后中等组53．8％，预后不良组45．5％，三组间比较差异有统计学意义（P=0．042）。化疗的不良反应主要为骨髓抑制和粒细胞缺乏所致感染，未见严重的非血液系统不良反应。结论预后良好组AML使用IA方案诱导化疗OR率和2年RFS率高，可作为首选方案，而预后中等、不良组RFS率较低，应尽早考虑移植治疗。

Objective To explore the clinical efficacy and toxicity of idarubicin （IDA）-based IA regimen as induction chemotherapy in treating acute myeloid leukemia （AML） within different risk groups. Methods Data collected in 60 patients initially diagnosed and treated with one course of IA regimen were studied retrospectively. Results Efficacy were different for patients treatment with different prognosis after one course of IA chemotherapy, CR rates achieved in patients with favorable, intermediate and unfavorable prognosis were 83.3 % （10/12）, 73.1% （19/26）, 59.1% （13/22） respectively, PR rates were 16.7 % （2/12）, 19.2 % （5/26）, 13.6 % （3/22） while OR rateswere 100% （12/12）, 92.3 % （24/26）, 72.7 % （15/22） respectively. After 2 years of follow-up, relapse free survival （RFS） rates were 100 % for patients with good prognosis, 53.8 % for those with moderate prognosis, and 45.5 % for people with poor prognosis. The outcome showed that there were significant differences among these three group （P = 0.042）. Myelosuppression and infections due to neutropenia were the main adverse effects, and severe non-hematologic toxicities were not observed. Conclusion IA regimen as induction chemotherapy may be an efficacious and safe solution and achieve a higher CR rate and 2 years RFS rate for patients diagnosed as AML with good prognosis. Hematopoietic stem cell transplantation should be considered as soon as possible for patients with moderate or poor prognosis.