不同挽救治疗方案对初始诱导失败和复发的急性髓系白血病患者的疗效比较

Efficacy Comparison of Different Salvage Treatment Regimens for Patients with Refractory/Relapsed Acute Myeloid Leukemia

目的:探讨MAC(米托蒽醌、阿糖胞苷、环磷酰胺)、FLAG(氟达拉滨、阿糖胞苷、粒系集落刺激因子)及CAG(阿糖胞苷、阿克拉霉素、粒系集落刺激因子)方案治疗初始诱导失败和复发的急性髓系白血病(AML)患者的疗效。方法:回顾性分析本中心2008年1月至2016年4月间经MAC、FLAG或CAG方案挽救治疗的初始诱导失败和复发的156例AML患者(除外急性早幼粒细胞白血病)的临床资料,按化疗方案分为156患者MAC组(60例)、FLAG组(45例)和CAG组(51例)。比较不同挽救方案的完全缓解率(CR)、部分缓解率(PR)、总生存(OS)、无病生存(DFS)以及治疗过程中的不良反应。结果:化疗后完全缓解率(CR),MAC组高于FLAG组和CAG组(55.4%vs 34.1%vs 34.0%)(P<0.05)。MAC、FLAG和CAG组的中位生存期分别为11、5.46和10.2个月,3个组生存率无明显差异(P>0.05)。骨髓抑制仍为主要的不良反应,3个组之间无统计学差异(P>0.05)。经MAC方案治疗的患者更多地出现粒细胞缺乏性发热(93.3%vs 86.7%vs 64.7%)(P<0.001);但致死性感染的发生率3组之间无统计学差异(5%vs 8.9%vs 5.9%)(P>0.05)。结论:与FLAG及CAG方案相比,MAC方案可以使更多的初始诱导失败和复发的AML患者获得缓解,且没有增加严重不良事件的发生,从而为更多的患者提供了后续进行造血干细胞移植的机会。

Objective ： To compare the efficacy and safety of 3 different regimens, namely MAC, FLAG and CAG, as the re-induction chemotherapy for acute myeloid leukemia （AML） patients with primary induction failure and relapse. Methods： The clinical data of 156 AML patients with primary induction failure and relapse, except patients with acute promyelocytic leukemia（ APL）, treated with any of the above 3 regimens in our center from January 2008 to April 2016 were analyzed retrospectively. According to the treatment regimens, 156 patients were divided into MAC group （ n = 60 ） , FLAG group （n = 45 ） and CAG group （n = 51 ）. The complete remission （CR） , partial remissison（ PR）, overall survival（ OS ）, disease-free survival（DFS） and adverse events during the treatment were analyzed, so as to compare and evaluate the efficacy and safety of the 3 different regimens. Results ： After 1 course of re-induction chemotherapy, CR in MAC group was significantly higher than that in FLAG and CAG group （55.4% vs 34.1% vs 34.0% ） （P 〈 0.05 ）. The OS was not statistically significantly different among 3 groups （ P 〉 0.05 ） with a median OS of 11 months, 5.46 months and 10.2 months, respectively. The myelosuppression was the main adverse event with no significant difference among the groups （ P 〉 0.05 ）. More patients treated with MAC regimen underwent febrile neutropenia （93.3% vs 86. 7% vs 64.7% ） （P 〈0.001 ）. However, the incidence of fatal infections was not signicantly different among 3 groups（5% vs 8.9% vs 5.9% ）（P 〉 0.05）. Conclusion： Compared with FLAG and CAG regimen, the MAC regimen can enable more AML patients with primary induction failure and refractory to achieve CR without increasing severe adverse events, therefore, this regimen may provide a opportunity for patients to recieve hematopoietic stem cell transplantation.