3种方案诱导治疗M_2,M_5型急性髓系白血病疗效观察

Therapeutic Effect Observation of Three Different Regimens in Acute Myelocytic Leukemia with Maturation and Acute Monocytic Leukemia

目的观察3种方案诱导治疗急性粒细胞白血病部分分化型(M2型),单核细胞白血病(M5型)急性髓系白血病疗效。方法单中心回顾性分析62例住院患者资料,22例应用IA方案比较去甲氧柔红霉素+阿糖胞苷(IA)、柔红霉素+阿糖胞苷(DA)、米托蒽醌+阿糖胞苷(MA)3种诱导化疗方案治疗临床常见的M2型和M5型1疗程的临床疗效。,25例应用DA方案,15例应用MA方案。结果应用IA方案的患者1个疗程完全缓解(CR)18例,部分缓解(PR)2例,完全缓解率为81.8%,总有效率为90.9%;应用DA方案的患者1个疗程CR 14例,PR 5例,完全缓解率为56.0%,总有效率为76.0%;应用MA方案的患者1个疗程CR 7例,PR 2例,完全缓解率为46.7%,总有效率为60.0%.IA组1个疗程CR率及有效率较DA,MA组差异有统计学意义(P<0.05),DA,MA组差异无统计学意义(P>0.05)。3组化疗方案的血液学不良反应为骨髓抑制,IA组与其它两组比较,差异有统计学意义(P<0.05),DA,MA组比较,差异无统计学意义(P>0.05)。结论 IA,DA,MA方案均可有效诱导治疗M2,M5型急性髓系白血病,IA方案明显优于DA,MA方案,但其化疗后骨髓抑制较重,需要加强抗感染及输血支持治疗。

Objective To compare idarubicin and cytarabine（ IA）,daunorubicin and cytarabine（ DA）,mitoxantrone and cytarabine（ MA） induced by 3 kinds of chemotherapy in the treatment of common clinical acute myeloid leukemia differentiation type（ M2 type） and monocytic leukemia（ M5 type） clinical curative effect 1 course. Methods To determine the efficacy of 3 regimens in 62 patients diagnosed as AML-M2/M5 from 2010 to 2016 in our hospital. Patients were divided into 3 groups and treated with IA/DA/MA individually,equivalent to 22 for IA,25 for DA and15 for MA. The outcomes of treatments were assessed by bone marrow smear followed by data analysis. Results Eighty of 22 patients achieved complete remission（ CR）,and 2 patients also achieved partial remission（ PR） with total efficacy90. 9% after IA was given. The total efficacy for DA and MA were 76. 0% and 60. 0% respectively. In DA group,the number of patients was 14 for CR,5 for PR. In the rest group,7 patients had good response to MA for CR,2 patients for PR. The hematologic adverse reaction of the three regimens is bone marrow suppression,the difference between IA and the other two groups were statistically significant（ P 〈0. 05）,the difference between DA and MA was of no statistical significance（ P 〉0. 05）. Conclusion IA,DA and MA all have effective induction therapy of acute myelocytic leukemia M2,M5. IA is obviously superior to DA and MA,but it has serious side effect of bone marrow suppression after chemotherapy and needs intensified anti-infection and blood transfution treatment.