中医序贯疗法联合DA方案诱导化疗治疗老年急性髓细胞白血病的疗效及安全性评价

Sequential Therapy of Traditional Chinese Medicine Combined with DA Regimen Induction Chemotherapy for the Treatment of Elderly Acute Myeloid Leukemi

探讨中医序贯疗法联合减低剂量的DA方案诱导化疗治疗初治老年急性髓细胞白血病(AML)的疗效及安全性。将90例初治老年AML患者按随机信封法分为2组,对照组45例仅进行减低剂量的DA方案诱导化疗,观察组45例在其基础上联合中医序贯疗法治疗(诱导化疗期在对照组基础上口服参芪杀白汤,骨髓抑制期则口服参芪仙补汤),2组均以4周为1个治疗周期,治疗2个周期后评估疗效。比较2组临床疗效、血常规变化情况、生活质量评分、化疗不良反应和长期疗效。结果显示:治疗后观察组CR率和总缓解率均高于对照组(P<0.05)。治疗前2组血常规指标(WBC、Hb、PLT)差异无统计学意义(P>0.05),治疗后2组WBC、Hb、PLT均较治疗前下降(P<0.05),观察组各指标水平均高于对照组(P<0.05)。治疗前2组生活质量评定量表(QOL-BREF)各维度评分无明显差异(P>0.05),治疗后2组症状、精神心理状态和生存质量评分均较治疗前下降(P<0.05),观察组症状、社会功能和生存质量评分均低于同期对照组(P<0.05)。2组均有胃肠道反应、电解质紊乱、肝肾损害、感染等不良反应,观察组发生率低于对照组(P<0.05)。2组一年生存率差异无统计学意义(P>0.05)。中医序贯疗法联合减低剂量的DA方案诱导化疗治疗初治老年AML能提高近期疗效,改善患者骨髓抑制和生活质量,减少化疗不良反应,是老年AML患者可耐受且疗效较理想的治疗方案。

The purpose of this paper is to explore the efficacy and safety of sequential Chinese medicine combined with reduced-dose DA regimen induction chemotherapy in the treatment of senile acute myeloid leukemia(AML).90 newly-treated elderly AML patients were divided into two groups according to the random envelope method,and 45 patients in the control group only received reduced-dose induction chemotherapy,while the other 45 cases in the observation group were combined with sequential treatment of traditional Chinese medicine on the basis of it(in the chemotherapy period,Shenqishabai decoction was taken orally in the control group,and Shenqixianbu decoction was taken in the bone marrow suppression period).4 weeks in both groups as one treatment cycle,and the curative effect was evaluated after 2 cycles of treatment.The clinical efficacy,blood routine changes,quality of life scores,adverse effects of chemotherapy and long-term efficacy were compared between the two groups.The results show that the CR rate and total remission rate of the observation group after treatment were higher than those of the control group(P<0.05).Before treatment,there was no significant difference in blood routine indexes(WBC,Hb,PLT)between the two groups(P>0.05).After treatment,WBC,Hb,PLT in both groups decreased compared with those before treatment(P<0.05).Both of them were higher than those in the control group(P<0.05).There was no significant difference in the scores of the QOL-BREF between the two groups before treatment(P>0.05).After treatment,the symptom perception,mental state and quality of life scores of the two groups were lower than those before treatment(P<0.05).In the observation group,the symptom perception,social function,and quality of life scores were lower than those in the control group during the same period(P<0.05).Both groups had gastrointestinal reactions,electrolyte disturbances,liver and kidney damage,infections and other adverse reactions.The incidence of the observation group was lower than that of the control group(P<0.05).There was no statistically significant difference in one-year survival rate between the two groups(P>0.05).Sequential therapy of traditional Chinese medicine combined with reduced-dose DA regimen induction chemotherapy for newly treated elderly AML could improve short-term treatment efficacy,bone marrow suppression and quality of life,with reduction of adverse reactions of chemotherapy.It is a tolerable and effective therapeutic plan for elderly AML patients.