小剂量HA方案治疗初诊成人高白细胞性急性髓系白血病

Outcome of low-dose HA regimen for newly diagnosed adult patients with hyperleukocytic acute myeloid leukemia

目的：观察小剂量HA方案治疗初诊成人高白细胞性急性髓系白血病（HAML）1个疗程后的疗效及不良反应。方法：23例初诊成人HAML患者,予以小剂量阿糖胞苷10mg/（m^2·d）,皮下注射,1次/12h,及高三尖杉酯碱2mg/d,静脉滴注,共14d。化疗过程中,白细胞计数〈10×10^9/L时予以粒细胞集落刺激因子300μg/d,皮下注射,直至中性粒细胞绝对值≥1.5×10^9/L时停用。结果：15例（65.2%）获得完全缓解,2例（8.7%）获得部分缓解,总有效率73.9%。6例无效,其中2例死亡,早期病死率8.7%。白细胞计数降至10×10^9/L以下所需时间为6（4-10）d。化疗期间主要不良反应为骨髓抑制,表现为粒细胞缺乏及继发感染、出血。结论：小剂量HA方案治疗初诊成人HAML有效率高,不良反应可控制。

Objective：To observe the efficacy and side effect of low-dose homoharringtonine（HHT）and cytarabine（Ara-C）on the newly diagnosed adult patients with hyperleukocytic acute myeloid leukemia（HAML）. Method：Twenty-three patients with HAML were treated with low-dose HA regimen：HHT 2mg/d and Ara-C 10 mg/（m^2·d）,q12hfor 14days,granulocyte colony stimulating factor（G-CSF）300μg/d,ih,when WBC10× 10^9/L until absolute neutrophil count≥1.5×10^9/L.Result：Fifteen patients（65.2%）achieved complete remission,two cases（8.7%）achieved partial remission.Six cases（26.1%）had no response and 2of them died.The overall response rate was 73.9% and the early mortality was 8.7%.It took 6（4to 10）days after low-dose HA treatment when the WBC counts decreased below 10×10^9/L.The main adverse reaction during the chemotherapy was myelosuppression and manifested as infection（caused by neutropenia）and bleeding.Conclusion：The efficacy of low-dose HA on newly diagnosed adult HAML is higher and the side effect is controllable.