含地西他滨化疗方案治疗初治老年人急性髓系白血病效果及预后分析

Efficacy and prognosis analysis of chemotherapy regimens including decitabine in treatment of newly elderly patients with acute myeloid leukemia

目的探讨含地西他滨化疗方案对初治老年急性髓系白血病(AML)患者的疗效及预后影响因素。方法回顾分析2013年2月至2017年11月在吉林大学第一医院接受含地西他滨化疗方案治疗的47例初治老年AML(M3除外)患者的临床资料,其中单药地西他滨组11例,地西他滨联合减量化疗组36例。分析治疗效果及不同因素对预后的影响。结果47例患者中,男性15例,女性32例,中位年龄65岁(60~83岁)。地西他滨联合减量化疗组1个疗程总反应率高于单药地西他滨组[80.6%(29/36)比27.3%(3/11),χ^2=8.693,P=0.003],起效疗程数少于单药地西他滨组(u=3.133,P=0.002);两组患者的中位总生存(OS)时间差异无统计学意义(14个月比12个月,P=0.950)。单因素分析显示达完全缓解(CR)组患者的中位OS时间长于未达CR组(17个月比5个月,P<0.01);原发老年AML患者中位OS时间长于继发AML患者(16个月比6个月,P=0.01)。Cox多因素分析结果显示未达CR是OS的独立不良影响因素(HR=0.180,95% CI 0.085~0.382,P<0.01)。地西他滨联合减量化疗组粒细胞缺乏伴发热发生率高于单药地西他滨组[69.4%(25/36)比36.4%(4/11),χ^2=3.902,P=0.048]。结论对于初治老年AML患者,含地西他滨化疗方案是安全有效的治疗手段。

Objective To explore the efficacy and prognostic factors of chemotherapy regimens including decitabine in treatment of elderly patients newly diagnosed with acute myeloid leukemia (AML).Methods The clinical data of 47 elderly patients newly diagnosed with AML (except M3) who received chemotherapy regimens including decitabine in the First Hospital of Jilin University from February 2013 to November 2017 were retrospectively analyzed,including 11 patients treated with single decitabine and 36 patients treated with decitabine combined with low-dose chemotherapy group.The treatment outcome and the impact of different factors on the prognosis were also analyzed.Results Of 47 patients,there were 15 males and 32 females,and the median age was 65 years old (60-83 years old).The overall response rate of decitabine plus low-dose chemotherapy group for 1 course was higher than that of single decitabine group [80.6%(26/36) vs.27.3%(3/11),χ^2=8.693,P=0.003],and the former showed less courses to acquire remission than the latter (u=3.133,P =0.002);however,there was no significant difference in the median overall survival (OS) time between the two groups (14 months vs.12 months,P =0.950).Univariate analysis indicated that the median OS time in the complete remission (CR) group was longer than that in the non-CR group (17 months vs.5 months,P < 0.01).The median OS time of the elderly patients with primary AML was longer than that of the patients with secondary AML (16 months vs.6 months,P =0.01).Cox multifactor analysis showed that failing to achieve CR was identified as an independent adverse influencing factor(HR =0.180,95% CI 0.085-0.382,P < 0.01).The incidence of neutropenia with fever in the patients treated with decitabine plus low-dose chemotherapy group was higher than that in single decitabine group [69.4%(25/36) vs.36.4%(4/11),χ^2 =3.902,P =0.048].Conclusion For newly elderly AML patients,chemotherapy regimens including decitabine are safe and effective.