HIA与IA方案治疗初治急性髓系白血病的临床对比观察

Clinical Comparative Observation of HIA and IA Regimen in Initial Treatment of Newly Diagnosed Acute Myeloid Leukemia

目的分别用去甲氧柔红霉素(IDA)与HA方案[高三尖杉酯碱(HH)+阿糖胞苷(Ara-C)]组成的双诱导HIA方案与传统IA方案治疗初治急性髓系白血病,比较两组化疗方案的疗效及不良反应。方法 HIA方案为:IDA7 mg/(m2.d),静脉滴注第1～3天;HH2.5 mg/(m2.d),静脉滴注,第1～5天;Ara-C100 mg/(m2.d),静脉滴注,第1～5天。IA方案为:IDA10 mg/(m2.d),静脉滴注,第1～3天;Ara-C100 mg/(m2.d),静脉滴注,第1～5天。结果 HIA方案组第一疗程74.4%(32/43)获CR,其中9例复发(早期复发1例,晚期复发8例)。IA方案组第一疗程73.3%(26/30)达CR,其中8例复发(早期复发5例,晚期复发3例)。两组在CR率和生存分析比较上差异均无明显统计学意义。但HIA方案组患者心脏不良反应发生率(2.3%)显著低于IA组(16.7%)。HIA方案化疗的不良反应主要为骨髓抑制和粒细胞缺乏所致感染,未见严重的非造血系统不良反应,尤其未加重心脏毒性,治疗过程中未发生早期死亡。结论 HIA方案可以减少蒽环类药物的剂量,不加重心脏毒性,增加了患者的耐受能力,且不影响疗效。

Objective Newly diagnosed acute myeloid leukemia patients were initially treated with conventional IA regimen and dual induction chemotherapy of HIA consisting of idamycin （IDA） regimen and HA [homoharringtonine （HH） ＋ cytosine arabinoside] regimen. Therapeutic effects and adverse effects of two regimens also were studied. Methods Forty-three patients were recruited into the HIA group （IDA 7 mg/（m2 .d）, Day 1-3; HH 2. 5 mg/（m2 .d）, Day 1-5; Ara-C 100 mg/（m2-d）, Day 1-5） and 30 patients into the IA group（IDA 10 mg/（m2 .d）, Day 1-3; Ara-C 100 mg/（m2 -d）, Day 1-5）. Results Complete remission （CR） rate was 74. 4% （32/43） in HIA group and 73. 3o/4 （26/30） in IA group in the first course. 9 patients relapsed during follow-up （1 early relapse and 8 late relapses）in patients achieved CR of HIA group, and 8 patients relapsed （5 early relapse and 3 late relapses） in IA group. No significant differences were observed between the two groups in terms of CR rate and survival. However,the inci- dence of heart adverse effects was significantly lower in HIA group （2. 3%） than that in the IA group （16. 7 %）. The adverse effects in HIA regimen were mainly infections resulted from bone marrow depression （BMD） and no serious non- hematopoietic system adverse effects and particularly aggravate cardiotoxicity were observed. No early death happened during the treatment course. Conclusion H1A regimen had acceptable effects and not aggravating cardiotoxicity although the dosage of anthracyclines was de- creased.