米托蒽醌、托泊替康联合阿糖胞苷治疗成人难治复发急性白血病的临床疗效观察

Clinical study on Mitoxantrone, Topotecan and Cytarabine regimen for treatment of adult refractory or relapsed acute leukemia

目的观察米托蒽醌、托泊替康联合阿糖胞苷（MTA）方案治疗难治复发急性白血病（AL）的临床疗效及毒副作用。方法20例难治复发急性白血病患者均采用米托蒽醌、托泊替康联合阿糖胞苷（MTA）方案诱导化疗，其中急性髓系白血病（AML）12例和急性淋巴细胞白血病（ALL）8例，包括难治6例及复发14例。结果①疗效：20例患者中11例（55．00％）获得完全缓解（CR），3例（15．00％）获得部分缓解（PR），6例无效（30．00％）；总有效率70．00％；②化疗不良反应：化疗后骨髓抑制期白细胞计数（wBc）耋1．0×10，／L的时间为6~23d，中位时间为10d；中性粒细胞（ANC）耋0．5X109^／L的时间为6-23d，中位时间为10d；血小板计数（PLT）s20×109^／L的时间为2～25d，中位时间为12d。所有患者均出现发热，2例（10．00％）于骨髓抑制期死于严重感染。结论MTA方案对于复发及难治AL均可取得良好的诱导缓解疗效，但其骨髓抑制较重而持久，应用该方案时应结合强力的支持、对症治疗及血液学监测。

[ Objective ] To observe the efficacy and side effect of MTA （Mitoxantrone, Topotecan and Cytarabine） regimen for the treatment of adult refractory or relapsed acute leukemia （AL）. [ Method ] Twenty patients were ad- ministrated with MTA regimen. Among these 20 patients, 12 cases were acute myeloid leukemia （AML） and 8 cases were acute lymphocytic leukemia （ALL）, while 6 were resistant and 14 were relapsed. [ Results ] （~）Clinical response： 11 out of 20 patients （55.00%） achieved complete remission （CR）, 3 cases （15.00%） achieved partial remission （PR）, 6 cases （30.00%） no response, with a total response rate of 70.00%; （~）Side effect： WBC reached its lowest point of below 1.0xl0~/L with ANC ~〈0.5x109/L at day 10 （range, 6~23 d） after the initiation of MTA regimen. The platelets count reached its lowest point of below 20x109/L at day 12 （range, 2~25 d） after the initiation of the regimen. All patients experienced fever and 2 patients （10.00%） died of severe infection due to bone marrow suppression. [ Con- clusions ] MTA is an effective regimen for relapsed and resistant AL. But it leads severe bone marrow supression and hematologic side effects. Thus intensive supportive care is essential for application of MTA regimen.