阿柔比星为基础的联合化学治疗方案治疗成人初治急性髓系白血病疗效观察

Efficacy of aclarubicin-based chemotherapy induction regimens for adult de-novo acute myeloid leukemia

目的比较以阿柔比星(Acla)为基础的高三尖杉酯碱(HHT)+Acla+阿糖胞苷(Ara-C)(HAA)方案与传统柔红霉素(DNR)+HHT+Ara-C(DHA)方案诱导缓解成人初治急性髓系白血病(AML)的近期疗效、远期生存及安全性。方法回顾性分析新乡市中心医院和新乡市第一人民医院2009年6月至2013年7月收治的104例成人初治AML患者的临床资料,其中56例患者(HAA组)接受HAA方案进行化学治疗,HHT 2 mg·m^(-2),第1~7天;Acla20 mg·d^(-1),第1~4天;Ara-C 100 mg·m^(-2),第1~7天。48例患者(DHA组)接受DHA方案进行化学治疗,DNR40~45 mg·m^(-2),第1~3天;HHT 2 mg·m^(-2),第1~7天;Ara-C 100 mg·m^(-2),第1~7天。比较2组患者的完全缓解率、3 a总生存率、无事件生存(EFS)率及不良反应等。结果 2组患者治疗1个疗程后完全缓解率比较差异无统计学意义(P>0.05);根据染色体核型分层后,2组各层患者完全缓解率比较差异均无统计学意义(P>0.05)。2个疗程后HAA组患者完全缓解率高于DHA组(P<0.05);根据染色体核型分层后,2组各层患者完全缓解率比较差异均无统计学意义(P>0.05)。HAA组患者3 a总生存率、EFS率分别为49.9%、41.6%,DHA组患者3 a总生存率、EFS率分别为43.7%、28.5%;2组患者3 a总生存率比较差异无统计学意义(P>0.05),HAA组患者3 a EFS率高于DHA组(P<0.05)。HAA组患者肌钙蛋白升高的发生率低于DHA组(P<0.05),2组患者其他不良反应发生率比较差异均无统计学意义(P>0.05)。结论 HAA能够提高成人初治AML的疗效,并改善患者生存情况,安全性好。

Objective To analyze the short-term efficacy,long-term survival,and safety of aclarubicin（ Acla）-based HAA regimens[homoharringtonine（ HHT） ＋ Acla ＋ cytarabine（ Ara-C） ] and traditional chemotherapy DHA regimens[daunorubicin（ DNR） ＋ HHT ＋ Ara-C] in treatment of adult de-novo acute myeloid leukemia（ AML）. Methods The clinical data of104 adult de-novo AML patients in the Central Hospital of Xinxiang and the First People＇ s Hospital of Xinxiang from June2009 to July 2013 were collected. Fifty-six patients received HAA treatment regimens（ HHT 2 mg·m^-2rom day 1 to 7; Acla20 mg·d-（-1）from day 1 to 4; Ara-C 100 mg·m^-2rom day 1 to 7）（ HAA group） and 48 patients received DHA treatment regimens（ DNR 40- 45 mg·m^-2rom day 1 to 3; HHT 2 mg·m^-2rom day 1 to 7; Ara-C 100 mg·m^-2rom day 1 to 7）（ DHA group）. The complete remission rate,overall survival（ OS） rate for three years,event free survival（ EFS） rate and adverse reaction of patients were compared between the two groups. Results There was no statistic difference of complete remission rate of patients between the HAA group and DHA group after one course of treatment（ P〉0. 05）; there was no significant difference in the complete remission rate of patients with different chromosome karyotype between the two groups（ P〈0. 05）. The complete remission rate of patients in HAA group was significantly higher than that in DHA group after two courses of treatment（ P〈0. 05）; there was no significant difference in the complete remission rate of patients with different chromosome karyotype（ P〉0. 05）. The 3-year OS rate and EFS rate of patients in the HAA group was 49. 9% and 41. 6%; the 3-year OS rate and EFS rate of patients in the DHA group was 43. 7% and 28. 5%; there was no significant difference of 3-year OS rate between the two groups（ P〉0. 05）; the EFS rate of patients in HAA group was significanlty higher than that in DHA group（ P〈0. 05）. The incidence of troponin elevation of patients in HAA group was significantly lower than that in DHA group（ P〈0. 05）; there was no statistic difference of the incidence of another adverse reaction of patients between the two groups（ P〉0. 05）. Conclusion HAA regimens can improve the efficacy and OS rate of patients with AML,and with the good safety.