中剂量阿糖胞苷用于老年急性髓系白血病患者巩固强化治疗的临床观察

Clinical observation of intermedium-dose cytarabine for consolidation therapy of elderly patients with acute myelogenous leukemia

目的 分析初治老年急性髓系白血病（AML）患者诱导缓解后应用中剂量阿糖胞苷（MDAC）巩固治疗的临床效果及不良反应.方法 61例2个疗程内达完全缓解（CR）的老年AML（M3除外）患者,分别应用MDAC和常规剂量阿糖胞苷（SDAC）进行巩固强化治疗,对其临床资料进行回顾性分析.结果 MDAC组26例,SDAC组35例,MDAC组与SDAC组的无复发生存（RFS）时间分别为42.7和16.0个月（P=0.002）,总生存（OS）时间分别为44.6和18.2个月（P=0.004）,累积复发率分别为26.9%（7/26）和54.3%（19/35）（x^2=4.567,P=0.033）,3年生存率分别为23.1%（6/26）和8.6%（3/35）（x^2=2.496,P=0.114）.两组不良反应发生率差异均无统计学意义（均P〉0.05）.结论 老年AML患者应用MDAC巩固强化治疗,可延长早期达CR患者的RFS及OS时间,不良反应发生率与SDAC相似.

Objective To investigate the effect of postremission consolidation therapy with intermedium-dose cytarabine （MDAC） in elderly patients with acute myelogenous leukemia （AML）. Methods Clinical data of 61 elderly AML patients （except M3） in postremission who achieved complete remission （CR） in two period of remission induction program were retrospectively analyzed. Results There were 26 cases in MDAC group and 35 cases in standard-dose cytarabine （SDAC） group. In MDAC group and SDAC group, the relapse free survival （RFS） time were 42.7 months and 16.0 months respectively （P= 0.002）, the overall survival （OS） time were 44.6 months and 18.2 months respectively （P= 0.004）, and the cumulative relapse frequencies rates were 26.9 % （7/26） and 54.3 % （19/35） respectively （x^2= 4.567, P= 0.033）. However, 3 years OS rate of the two groups were 23.1%（6/26） and 8.6%（3/35） （x^2=2.496, P=0.114） , and there was no significant difference in the incidence of adverse reactions between the two groups （all P 〉 0.05）. Conclusion MDAC could improve RFS and OS for the elderly AML patients in postremission who received CR in the early stage, and the incidence of adverse reactions is similar to that of SDAC.