预激方案和标准方案治疗初治急性髓系白血病的临床观察

A comparison between priming induction regimen and standard chemical therapy in treatment of de novo acute myeloid leukemia

目的:比较预激方案与标准化学治疗(化疗)方案治疗初治急性髓系白血病(AML)的疗效、不良反应和生存情况。方法:回顾性分析175例可随访的初治AML患者,分成预激方案组(n=60)和标准方案组(n=115),标准方案组采用IA(去甲氧柔红霉素、阿糖胞苷)或DA(柔红霉素、阿糖胞苷),预激方案组采用CAG(阿克拉霉素、阿糖胞苷和粒细胞集落刺激因子)或IAG(去甲氧柔红霉素、阿糖胞苷和粒细胞集落刺激因子)诱导治疗,2组患者均为一疗程缓解,同方案巩固2个疗程,或2个疗程缓解,同方案巩固一疗程,随后进入巩固维持治疗阶段。结果:预激方案组与标准方案组在完全缓解率、无病生存率和总生存率方面差异无统计学意义(均P>0.05),但预激方案组患者化疗后骨髓恢复时间、感染发生率及单采血小板的输注量均低于标准方案组患者(均P<0.05)。结论:预激方案在治疗初治AML的临床疗效和患者生存情况与标准方案相类似,但骨髓抑制及感染发生等不良反应较标准方案轻微,故可作为初治AML患者诱导治疗的可选方案之一。

Objective To compare the efficacy,side effects and survival between priming induction regimen and stan-dard chemical therapy in de novo patients with acute myeloid leukemia（AML）.Methods There were 175 de novo AML patients included in this study：115 patients were treated with standard induction regimen（IA/DA,idarubicin and cytara-bine/daunorubicin and cytarabine）;60 patients were treated with priming induction regimen（CAG/IAG,cytarabine,aclarubicin and granulocyte colony-stimulating factor/idarubicin,cytarabine and granulocyte colony-stimulating factor）.After reaching complete remission（CR） with one or two course of induction chemotherapy,the patients in the two groups received the respective same regimen as induction chemotherapy for consolidation followed by maintenance therapy.Results There were no significant differences in the rate of CR and overall response,disease free survival and overall sur-vival between the two groups（all P〉0.05）.But the recovery time of bone marrow,incidence of infection and platelet trans-fusion in priming induction group was significantly shorter or lower than that in standard chemical therapy group（all P0.05）.Conclusions Our study suggested that the priming induction regimen was similar to standard chemical therapy in treatment efficacy and survival.But the adverse effects,including myelosuppression and infection,were mild in priming in-duction regimen.Therefore,the priming induction regimen can be considered as the alternative therapy regimens for de novo AML patients.