全反式维甲酸联合小剂量阿糖胞苷治疗老年急性髓系白血病临床观察

Clinical observation of all-trans retinoic acid combined with low-dose cytarabine in the treatment of elderly patients with acute non-promyelocytic leukemia

目的全反式维甲酸联合小剂量阿糖胞苷对老年急性髓系白血病患者的疗效。方法我院确诊的不能耐受或不愿意接受标准化疗的老年急性非早幼粒细胞白血病(AML)患者86例,分为治疗组45例和对照组41例。对照组予单纯小剂量阿糖胞苷治疗,治疗组在对照组的基础上予全反式维甲酸治疗。两组每4周复查一次骨髓涂片,评价疗效。比较两组28天死亡率、完全缓解率、及治疗后6月生存率情况。采用聚合酶链反应结合HRM、聚合酶链反应集合DHPLC技术相对定量检测NPM1基因突变情况,分析其与患者完全缓解率、6月生存率的关系。结果治疗组28天死亡率低于对照组,完全缓解率、6个月生存率高于对照组。治疗组NPM1阳性患者完全缓解率高于NPM1阴性患者(P <0. 05),6月生存率比较差异无统计学意义(P> 0. 05)。结论全反式维甲酸联合小剂量阿糖胞苷可以延长老年AML患者的生存,对于NPM1基因突变阳性患者需引起临床重点关注。

To evaluate the efficacy of all-trans retinoic acid combined with low-dose cytarabine in the treatment of elderly patients with acute myeloid leukemia(AML).Eighty-six elderly patients with AML diagnosed in our hospital and unfit for or unwilling to receive standard chemotherapy.The patients were divided into treatment group(n=45)and control group(n=41).The control group received simple cytarabine therapy while the treatment group received low-dose cytarabine plus all-trans retinoic acid.Bone marrow was reexamined every 4 weeks to evaluate the curative effect.The 28-day mortality rate,complete remission rate and 6-month survival rate were compared between the two groups.At the same time,polymerase chain reaction(PCR)with high resolution melting(HRM)analysis and PCR with denaturing high performance liquid chromatography(DHPLC)were used to detect the mutation of NPM1 gene.The relationship between total remission rate and 6-month survival rate was analyzed.The 28-day mortality rate of the treatment group was lower and the rate of complete remission and 6-month survival rate were higher than those of the control group.The complete remission rate of NPM1 positive patients in the treatment group was higher than that of NPM1 negative patients(P<0.05)but the difference in the 6-month survival rate was not statistically significant(P>0.05).All-trans retinoic acid combined with low-dose cytarabine can prolong the survival of elderly patients with AM.Of note,patients with NPM1 gene mutation should be paid with clinical attention.