改良Hyper-CVAD方案在中老年Ph阴性急性淋巴细胞白血病患者中的应用效果观察

Application effect observation of modified Hyper-CVAD program in middle-aged and elderly patients with Ph negative acute lymphoblastic leukemia

目的探讨改良Hyper-CVAD方案在中老年Ph阴性急性淋巴细胞白血病(ALL)患者中的应用效果。方法 48例中老年Ph阴性ALL患者,随机分为改良组和常规组,各24例。改良组给予改良Hyper-CVAD方案诱导化疗治疗,常规组给予常规Hyper-CVAD方案诱导化疗治疗。比较两组患者随访1年后空腹血糖、外周原始细胞百分比以及外周血白细胞数,继发高血糖、复发、霉菌感染及1年生存情况。结果随访1年后,改良组的空腹血糖、外周原始细胞百分比以及外周血白细胞数均显著低于常规组,差异具有统计学意义(P<0.05)。改良组中继发高血糖发生率8.33%以及霉菌感染发生率4.17%均明显低于常规组的41.67%、33.33%,差异具有统计学意义(P<0.05);两组患者复发率及1年生存率比较差异无统计学意义(P>0.05)。结论改良Hyper-CVAD方案诱导化疗有利于显著减少继发糖尿病的发生,建议在临床推广。

Objective To explore the application effect of modified Hyper-CVAD program in middleaged and elderly patients with Ph negative acute lymphocytic leukemia（ALL）. Methods A total of 48 middleaged and elderly patients with Ph negative ALL were randomly divided into modified group and conventional group, 24 cases in each group. The modified group was treated with modified Hyper-CVAD program induction chemotherapy, the conventional group was treated with conventional Hyper-CVAD program induction chemotherapy. The fasting blood glucose, the percentage of peripheral primitive cells and the number of white blood cells in peripheral blood, and secondary hyperglycemia, recurrence, fungal infection and 1 year survival were compared between the two groups after 1 year of follow-up. Results After 1 year of follow-up, the fasting blood glucose, the percentage of peripheral primordial cells and the number of white blood cells in the peripheral blood of the modified group were significantly lower than those of the conventional group, the differences were statistically significant（P0.05）. The incidence of secondary hyperglycemia and fungal infection in the modified group were 8.33% and 4.17% respectively, which were significantly lower than 41.67% and 33.33% in the conventional group, the differences were statistically significant（P0.05）. There were no statistically significant differences in the recurrence rate and the 1 year survival rate between the two groups（P0.05）. Conclusion Modified Hyper-CVAD program induction chemotherapy is beneficial to significantly reduce the incidence of secondary diabetes, and it is recommended for clinical promotion.