不同剂量阿糖胞苷对急性髓性白血病缓解后巩固治疗的疗效分析

Therapy analysis of consolidation treatment with different doses of cytarabine for acute myeloid leukemia

目的:探讨不同剂量阿糖胞苷对急性髓性白血病(AML)缓解后巩固治疗的疗效和安全性。方法:将62例经过诱导化疗取得完全缓解的AML患者,随机分为大剂量阿糖胞苷组(29例)和中剂量阿糖胞苷组(33例),在完全缓解后分别给予不同剂量的单药阿糖胞苷[2.0g/(m^2·次)及1.0~1.5g/(m^2·次),1次/12h,第1、3、5天],共6次为1个疗程,同组患者相同方案巩固4个疗程,随访12~48个月。结果:大剂量阿糖胞苷组1、2、3年的无复发生存率分别为93.8%、77.9%和56.8%,中剂量阿糖胞苷组1、2、3年的无复发生存率分别为83.5%、50.6%和23.1%,2组间比较差异有统计学意义(P<0.05);2组患者持续缓解时间差异无统计学意义;大剂量阿糖胞苷组患者的肺部感染发生率高于中剂量阿糖胞苷组,差异有统计学意义(55.2%∶36.4%,P<0.05)。结论:大剂量阿糖胞苷巩固治疗AML的疗效相比中剂量更有优势,在加强感染预防与治疗准备的前提下,值得进一步临床推广。

Objective：To study the efficacy and safety of different doses of cytarabine as consolidation therapy in patients with acute myeloid leukemia（AML）after remission.Method：Sixty-two cases of ALL patients who had achieved remission after induction chemotherapy were randomly divided into high dose group（n=29）and middle dose group（n=33）.After achieving complete remission,the patients in 2groups were treated with different doses of single cytarabine[2.0g/（m^2·time）or 1.0to 1.5g/（m^2·time）,once per 12 h,d1,3,5]as consolidation for 4 courses,and followed up for 12 to 48 months.Result：Relapse-free survival rate of high dose group in 1,2and3 years respectively were 93.8%,77.9% and 56.8%,and relapse-free survival rate of middle dose group in 1,2 and 3years respectively were 83.5%,50.6% and 23.1%.There were significant differences between 2 groups（P〈0.05）.The sustained remission time between 2 groups had no statistically significance.The incidence of pulmonary infection of high dose group was higher than that of the middle dose group,the differences were statistically significant（55.2% vs.36.4%,P〈0.05）.Conclusion：Consolidation therapy of high dose cytarabine in AML patients shows an advantage of curative effect over middle dose.On the premise of strengthening the prevention and treatment of infection,it deserves further clinical promotion.