米托蒽醌联合阿糖胞苷个体化方案在急性髓细胞白血病诱导化疗的应用研究

A Clinical Study on Mitoxantrone Combined with Cytarabine Individualization Program in Induction Chemotherapy of Acute Myeloid Leukemia

目的探讨米托蒽醌联合阿糖胞苷(Ara-C)个体化方案初治急性髓细胞白血病(AML)的临床疗效及毒副作用。方法将2008年2月—2011年9月我科收治的108例初治AML按危险度分级分为低危组15例,标危组51例,高危组42例。均接受米托蒽醌联合阿糖胞苷的3+n d(n≥7)方案进行化疗,统计比较1疗程结束后的3组缓解率、骨髓抑制程度及感染发生率等。结果 3组在化疗7 d或>7 d病例分布方面比较无统计学差异(P>0.05)。108例化疗1疗程后完全缓解(CR)75例(69.4%),部分缓解(PR)22例(17.6%),总有效率为87%。低危组CR率93.3%(14/15),标危组CR率70.6%(36/51),高危组CR率59.5%(25/42),3组比较差异有统计学意义(P<0.05)。3组在骨髓抑制程度及持续时间方面比较均无统计学差异(P>0.05)。108例中94例(76.8%)在化疗期间合并感染,经积极抗感染治疗后均治愈,无治疗相关死亡事件。低危组感染率为86.7%(13/15),标危组为84.3%(43/51),高危组为85.7%(36/42),3组比较差异无统计学意义(P>0.05)。结论米托蒽醌联合Ara-C个体化方案用于AML的诱导化疗,疗效肯定,费用相对低廉,患者耐受性良好,安全性可靠,便于临床应用及推广。

Objective To explore the clinical efficacy and side-effects of mitoxantrone combined with cytarabine individual- ized program in the initial stage of treatment of acute myeloid leukemia （AML）. Methods A total of 108 patients initially treated as having AML in our department during February 2008 and September 2011 were classified low-risk group （n = 15） , standard-risk group （n = 51 ） and high-risk group （n = 42）. And patients were given the 3 ＋ n d （n/〉7） program of mitoxantrone combined with cytarabine chemotherapy, and the remission rates, the degree of bone marrow suppression and infection incidence rates of the 3 groups after 1 course of treatment were recorded and compared. Results The differences in cases distribution of the 3 groups after 7 d or 〉 7 d, chemotherapy was of no statistical significance （P 〉 0. 05）. After 1 course of chemotherapy, there were 75 cases （69.4%） of complete remission （CR）, 22 cases （17.6%） of partial remission （PR）, and the total effective rate was 87%. The CR rates were 93.3% （14/15） in low-risk group, 70.6% （36/51） in the standard-risk group and 59.5% （25/42） in the high-risk group. And the differences of the 3 groups were of statistical significance （P 〈0. 05） , but the differences in bone marrow suppres- sion and duration of the 3 groups was of no statistical significance （P 〉0. 05）. In 108 cases, there were 94 cases （76.8%） of con- current infection during chemotherapy, and after an active anti-infection treatment, all infection cases were cured without any related deaths. The infection rates were 86.7% （13/15） in the low-risk group, 84.3% （43/51） in the standard-risk group and 85.7% （36/42） in the high-risk group. The differences in the 3 groups was not statistically significant （P 〉0. 05）. Conclusion Mitox- antrone combined with cytarabine individualized program in the initial treatment of AML has certain efficacy. It has low cost, good tolerance and reliable security in clinical application.