去甲氧柔红霉素诱导治疗急性髓系白血病的效果

Idarubicin as induction chemotherapy reduces relapse for patients with newly diagnosed acute myeloid leukemia

目的比较吡柔比星联合阿糖胞苷(TA方案)与去甲氧柔红霉素联合阿糖胞苷(IA方案)治疗初治急性髓系白血病(AML)的效果与不良反应。方法回顾性分析IA、TA方案诱导治疗初治AML患者91例,随访至2013年9月,比较两方案的疗效、不良反应。结果 IA与TA方案诱导化疗的完全缓解率、总反应率、不良反应的差异无统计学意义(P>0.05)。IA方案中位无复发生存比TA方案明显延长(分别14.14和9.36个月),差异有统计学意义(P=0.010);IA方案患者超过6个月的疾病复发率明显低于TA方案(15.8%vs 48.6%,P=0.002);总生存时间和3年生存率的差异无统计学意义(P>0.05)。结论在初治AML诱导治疗方案中,与TA方案相比,IA方案明显减少患者>6个月疾病复发率,延长无复发生存。

Objective To compare the efficacies and toxicities of idarubicin combined with cytarabine（ IA） and therarubicin combined with cytarabine（ TA） in newly diagnosed acute myeloid leukemia patients.Methods The clinical efficacy,including response rates,relapse free survival（ RFS）,overall survival（ OS）,and toxicities in a retrospective series of 91 newly diagnosed AML（ non-APL） patients treated with two chemotherapy regimens from January 2005 to January 2011 were compared.The patients were followed up until September 2013.Results There was no significant difference in complete response rate（ CRR） and overall response rate（ ORR） between IA and TA groups（ 60.9% vs 51.1%,P = 0.348 and 78.3% vs.77.8%,P = 0.956,respectively）.Significant longer RFS was revealed in IA group than TA group（ 14.14 months vs.9.36 months,P = 0.010）.Moreover,the disease relapse rate in IA group was significantly lower than TA group（ 15.8% vs.48.6%,P = 0.002） after 6 months of initiating chemotherapy.However,there was no significant difference in OS and 3-year survival between IA group and TA group（ 15.56 months vs.10.48 months,P = 0.076,and 34.8% vs.22.2%,P = 0.185,respectively）.Treatment-related neutropenia was significantly severer in IA group than TA group（ P = 0.039）.There was no significant difference in chemotherapy-induced complication between the two groups（ P 〉0.05）.Conclusion IA as induction chemotherapy significantly reduces relapse and improve RFS comparing to TA in newly diagnosed AML patients.