预激CAG方案治疗老年初治急性髓系白血病的临床分析

Clinical analysis of priming induction regimen CAG for treatment of newly diagnosed acute myeloid leukemia in elderly patients

目的:评价CAG(阿糖胞苷、阿柔比星、粒细胞集落刺激因子)方案治疗老年初治急性髓系白血病(AML)的疗效及不良反应。方法:64例老年初治AML作为观察对象,其中39例患者予以CAG预激方案治疗,完全缓解(CR)后序贯予原方案、HA(高三尖杉酯碱和阿糖胞苷)、DA(柔红霉素和阿糖胞苷)、MA(米托蒽醌、阿糖胞苷)、中剂量阿糖胞苷巩固治疗至少2个循环;25例患者予以标准方案DA或HA方案化学治疗(化疗),CR后序贯予HA或DA、MA、中剂量阿糖胞苷至少2个循环。观察其疗效及不良反应。结果:CAG预激治疗组1个疗程CR 17例,2个疗程CR 6例,总CR率为59%,7例部分缓解(PR),总有效率77%。常规化疗组患者中1个疗程CR 7例,2个疗程CR 4例,总CR率为44%,2例PR,总有效率52%,与CAG预激治疗组相比差异有统计学意义(P<0.05);CAG组的胃肠道反应、感染、出血、脱发、肝功能及肾功能受损、心毒性、骨髓抑制不良反应发生率均明显少于常规化疗组,差异均有统计学意义(均P<0.05)。但CAG方案化疗的老年患者中位生存时间(12.0±1.9)个月,而常规化疗患者中位生存时间(5.0±1.9)个月,2组总生存时间(OS)差异无统计学意义(P>0.05)。结论:CAG预激方案治疗初治老年AML患者较之传统常规治疗具有有效率高、不良反应较小、患者生活质量高的优点,适合老年AML患者使用。

Objective To evaluate the efficacy and toxicity of priming induction regimen CAG （cytarabine ＋ aclarubincin ＋ granulocyte colony-stimulating factor） for newly diagnosed acute myeloid leukemia （AML） in elderly patients. Methods Sixty four patients with newly diagnosed AML were divided into 2 groups： 39 patients were treated with priming induction regimen CAG and the other 25 were treated with one of the two classic routine chemotherapy regimens, including pirarubicin ＋ cytarabine （DA） and homoharringtonine ＋ cytarabine （HA）. Patients of the first group were treated with CAG and thereafter HA, DA, MA（mitoxantrone＋ cytarabine）, and medium-dose cytarabine for at least two cycles after complete remission （CR）. Patients of the second group were treated with HA or DA, MA, and medium-dose cytarabine for at least two cycles after CR. Evaluate the efficacy and side effects. Results The complete remission rate after 2 courses of induction therapy and total efficacy rate in the priming induction regimen CAG group were significantly higher than that in the routine chemotherapy group （59% vs. 44%, 77% vs. 52%） （P〈0.05）. The side effects in priming induction CAG group were significantly fewer than those in the routine chemotherapy group （P〈0.05）. The median survival time in priming induction CAG regimen group was （12.0±1.9） months, and that in the routine chemotherapy group was （5.0±1.9） months; the overall survival time （OS） between the two groups was not significantly different （P〉0.05）. Conclusions The priming induction regimen CAG group had a significantly higher complete remission rate and total efficacy rate, fewer side effects and higher quality of life than the routine chemotherapy group. Therefore, it is suitable for elderly patients with AML.