标准剂量IA方案治疗≥55岁初诊急性髓系白血病患者效果观察

Efficacy observation of standard-dose IA regimen in treatment of ≥ 55 years old newly diagnosed patients with acute myeloid leukemia

目的 探讨标准剂量IA方案治疗≥55岁初诊急性髓系白血病（AML）患者的疗效及不良反应.方法 回顾性分析江苏省人民医院血液科收治的32例≥55岁初诊AML患者应用标准剂量IA方案诱导治疗后的缓解情况、生存情况和治疗相关不良反应.结果 32例患者经IA方案诱导治疗后完全缓解（CR）率为71.9%（23/32）,部分缓解（PR）率为9.4%（3/32）,总有效（OR）率为81.3%（26/32）.按细胞遗传学或分子生物学指标分组：预后良好组7例,CR 6例,PR 1例,OR率100.0%（7/7）;预后中等组19例,CR 14例,PR 2例,OR率84.2%（16/19）;预后不良组6例,CR 3例,PR 0例,OR率50.0%（3/6）;三组CR率和OR率比较差异均无统计学意义（χ2=5.571,P=0.067;χ2=2.114,P=0.359）.预后良好、中等和不良组的中位总生存（OS）时间分别为28.07个月（6.57~46.33个月）、16.93个月（0.40~87.57个月）和3.03个月（2.00~6.00个月）,差异有统计学意义（Z=9.630,P=0.008）;2年OS率分别为83.33%、46.80%和0,差异亦有统计学意义（χ2=12.206,P〈0.001）.化疗后主要不良反应为骨髓抑制及感染,未发生严重非血液系统不良反应.结论 ≥55岁初诊AML患者可选择标准剂量IA方案作为诱导方案.预后良好组和预后中等组患者诱导治疗后OR率、CR率高,OS时间长,而预后不良组患者未能从治疗中获益.

Objective To explore the clinical efficacy and toxicity of standard-dose IA regimen as induction chemotherapy in treating initially diagnosed acute myeloid leukemia （AML） patients ≥55 years old. Methods A total of 32 patients were enrolled in this study. The remission, survival time and adverse effects after IA regimen were retrospectively analyzed. Results The complete remission （CR） rate, partial remission （PR） rate and overall response （OR） rate were 71.9%（23/32）, 9.4%（3/32）, 81.3%（26/32） after IA regimen. In favorable, intermediate and poor prognosis groups （grouped by cytogenetic or molecular factors）, 6, 14 and 3 cases achieved CR （χ2= 5.571, P= 0.067）, 1, 2 and 0 cases achieved PR, while OR rates were 100.0 %（7/7）, 84.2 % （16/19）, 50.0 % （3/6） （χ2= 2.114, P= 0.359）. The median overall survival （OS） time of three groups were 28.07 months （6.57-46.33 months）, 16.93 months （0.40-87.57 months） and 3.03 months （2.00-6.00 months） （Z=9.630, P=0.008） and the 2-year OS rates were 83.33%, 46.80%and 0, respectively （χ2=12.206, P〈 0.001）. Myelosuppression and infections due to neutropenia were the main adverse effects and severe non-hemotologic toxicities were not observed. Conclusion The standard-dose IA regimen can increase CR/OR rate and prolong the median OS time of patients with favorable and intermediate prognosis and it can be used as the first induction chemotherapy regimen for elderly AML patients of ≥55 years old.