加大剂量CAG方案与标准剂量阿糖胞苷方案再诱导治疗部分缓解急性髓系白血病效果比较

Comparison of efficacy between high-dose CAG regimen and standard-dose cytarabine regimen for acute myeloid leukemia patients with partial remission after the first course of standard induction chemotherapy

目的比较加大剂量CAG（HD-CAG，即增加传统CAG方案中阿柔比星的剂量）方案和标准剂量阿糖胞苷（SDAC）的联合方案（阿糖胞苷联合柔红霉素/去甲氧柔红霉素）对部分缓解（PR）急性髓系白血病（AML）患者的再诱导疗效。 方法回顾性分析2006年10月至2015年9月苏州大学附属第一医院和海口市人民医院收治的49例经＂3＋7＂标准诱导化疗方案治疗后仅获得PR的AML患者，根据不同的再诱导方案，这些患者被分为HD-CAG组（23例）和SDAC组（26例），对比分析两组患者的临床特征、疗效、不良反应及生存率。 结果HD-CAG组的完全缓解（CR）率高于SDAC组[91.3%（21/23）比65.4%（17/26），P=0.030]，两组的总体反应（OR）率分别为95.7%（22/23）和84.6%（22/26），差异无统计学意义（P=0.423），化疗后两组的骨髓抑制及感染发生率差异均无统计学意义（均P〉0.05）。两组的12个月总生存（OS）率和无病生存（DFS）率差异均无统计学意义（P=0.287，P=0.816）。 结论HD-CAG方案再诱导治疗经＂3＋7＂方案取得PR的AML患者，可以获得较SDAC联合方案更好的疗效。

ObjectiveTo compare the efficacy of high-dose CAG （HD-CAG） regimen by increasing the dose of aclarubicin in conventional CAG regimen and standard-dose cytarabine （SDAC） combination regimen in acute myeloid leukemia （AML） patients with partial remission （PR） after standard induction regimen. MethodsThis study retrospectively analyzed 49 PR AML patients after 3 days of daunorubicin or idarubicin and 7 days of cytarabine regimen （namely ＂3＋7＂ ） in the First Affiliated Hospital of Soochow University and Haikou Municipal People＇s Hospital from October 2006 to September 2015. Based on different reinduction regimen, these patients were divided into 2 groups： HD-CAG （23 cases） and SDAC （26 cases）. The clinical characteristics, efficacy, toxicity and survival rate were further evaluated between 2 groups. ResultsThe complete remission （CR） rate in HD-CAG group was higher than that in SDAC group [91.3% （21/23） vs. 65.4% （17/26）, P=0.030], while the overall response （OR） rate between 2 groups was not statically different [95.7% （22/23） vs. 84.6% （22/26）, P=0.423]. Meanwhile, myelosuppression and infection rate of HD-CAG regimen were similar with SDAC regimen. There were no statistically significant differences in overall survival （OS） and disease free survival （DFS） rates at 12 months between 2 groups （P=0.287, P=0.816）. ConclusionThe HD-CAG regimen could obtain a better efficacy than SDAC regimen for these AML patients with PR after the first course of standard induction chemotherapy.