中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿的疗效及安全性

Efficacy and safety of mid-dose cytarabine combined with mitoxantrone and etoposide in the treatment of refractory recurrent acute myeloid leukemia

目的探讨中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性急性髓系白血病(AML)患儿的疗效及安全性。方法选取2008年12月～2012年12月我院收治的行阿糖胞苷联合米托蒽醌、依托泊甙巩固治疗的难治复发性AML患儿96例作为研究对象,采用回顾性分析法分析所有患儿的临床及随访资料,根据阿糖胞苷使用剂量的不同将其分为低剂量组、中剂量组和高剂量组3组,每组各32例,治疗结束后分析并比较3组患儿近期和远期临床疗效,并记录3组患儿治疗过程中不良反应的发生情况。结果近期临床总有效率3组相比较差异均无统计学意义(P>0.05),且所有部分缓解的患儿中8例患儿进行骨髓移植治疗后治愈,余42例继续采用药物进行治疗;3组患儿5年总生存率(OS)比较差异有统计学意义(P<0.05),中剂量组和高剂量组患儿5年OS均高于低剂量组(P<0.05),但中剂量和高剂量组5年OS比较差异无统计学意义(P>0.05),3组患儿其5年无事件生存年率(EFS)比较差异均无统计学意义(P>0.05);3组患儿在骨髓抑制和心脏毒性的不良反应方面比较差异无统计学意义(P>0.05),但中剂量组和高剂量组患儿其感染、胃肠道反应以及肝肾功能损伤的不良反应发生率均显著高于低剂量组,且高剂量组患儿胃肠道和肝肾功能损伤的不良反应发生率均高于中剂量组患儿,组间比较差异均有统计学意义(P<0.05)。结论中剂量阿糖胞苷联合米托蒽醌及依托泊甙巩固治疗对难治复发性AML患儿具有较好的临床疗效和较低的毒副反应,存在一定的安全性,可作为临床上治疗AML患儿的首选治疗方案。

Objective To investigate the efficacy and safety of mid-dose cytarabine combined with mitoxantrone and etoposide in the treatment of refractory recurrent acute myeloid leukemia (AML).Methods 96 refractory recurrent AML patients from December 2008 to December 2012 in our hospital were selected as the study subjects.The clinical and follow-up data of all patients were analyzed by retrospective analysis.All the patients were given cytarabine mitoxantrone and etoposide consolidation treatment.However,according to the different doses of cytarabine,they were divided into low dose group,medium dose group,high dose group,each 32 cases.After the treatment,the clinical efficacy of the three groups of patients was analyzed and compared in the short and long term,and record the two groups of patients in the course of treatment of adverse reactions.Results The total recent clinical total efficiency of the three groups were not different.8 of the patients with partial remission were cured after bone marrow transplantation,and the remaining 42 patients continued to be treated with drugs.The difference of 5-year OS was statistically significant between the three groups ( P <0.05).The 5-year OS of middle-dose group and high-dose group were higher than that of low-dose group,but middle-dose and high-dose group.There was no difference in 5-year OS.There was no difference in 5-year EFS between the three groups ( P >0.05).There were no differences in the adverse reactions of myelosuppression and cardiotoxicity between the three groups ( P >0.05).However,the incidence of infection,gastrointestinal reaction and liver and renal dysfunction were significantly higher in the middle-dose group and the high-dose group than in the low-dose group.The incidence of gastrointestinal tract injury and liver and kidney dysfunction in high-dose group were higher than those in middle-dose group,with statistical significance ( P <0.05).Conclusion The combination of middle dose of cytarabine and mitoxantrone and etoposide can improve the clinical curative effect and reduce toxicity of refractory recurrent AML.This method deserves to be the first choice of treatment for AML in clinic.