不同化疗方案对初始诱导失败急性髓性白血病患者近期疗效、生存期及不良反应的影响

Effects of Different Chemotherapy Regimens on Short⁃Term Efficacy,Survival Time and Adverse Reactions in Patients With Acute Myeloid Leukemia After Initial Induction Failure

目的探讨不同化疗方案对初始诱导失败急性髓性白血病(acute myeloid leukemia,AML)患者近期疗效、生存期及不良反应的影响。方法回顾性纳入2017年1月~2019年12月华北石油管理局总医院收治的120例初始诱导失败AML患者,按照治疗方案的不同分为FLAG方案[氟达拉滨(fludarabine,Flud)联合阿糖胞苷(cytarabine,Ara-C)及粒细胞集落刺激因子(granulocyte colony stimulating factor,G-CSF)]组、CAG方案[阿柔比星(aclarubicin,Acla)联合Ara-C及G-CSF]组及MAC方案[米托蒽醌(mitoxantrone,MTZ)联合环磷酰胺(cyclophosphamide,CTX)及Ara-C]组,每组40例。比较3组的近期疗效、生存期及不良反应。结果MAC方案组的完全缓解率(complete response,CR)明显高于FLAG方案组及CAG方案组(52.50%vs.32.50%、35.00%,P<0.05),总缓解率(overall response rate,OR)明显高于FLAG方案组(65.00%vs.42.50%,P<0.05),3组之间的部分缓解(partial response,PR)比较差异无统计学意义(P>0.05);MAC方案的总生存期(overall survival,OS)均明显高于FLAG方案组及CAG方案组[32.6个月(2.0~47.5)vs.19.7个月(1.5~28.4)、13.0个月(1.6~25.2),P<0.05],3组之间的无病生存率(disease-free survival,DFS)比较差异无统计学意义(P>0.05);MAC方案及CAG方案组的感染发生率均明显高于FLAG方案组(82.50%、77.50%vs.50.00%,P<0.05),3组之间的其他不良反应发生率比较差异无统计学意义(P>0.05)。结论MAC方案能够明显提高初始诱导失败AML患者的近期疗效及生存期,而感染发生率较高,但不是严重不良反应,总体价值相对高于FLAG方案及CAG方案。

Objective To investigate the effects of different chemotherapy regimens on short⁃term efficacy,survival and adverse reactions in patients with acute myeloid leukemia(AML)after initial induction failure.Methods 120 cases of AML patients after initial induction failure were retrospectively included in Huabei Petroleum Administration Bureau General Hospital from January 2017 to December 2019.According to different treatment regimens,they were divided into FLAG regimen[fludarabine(Flud)combined with cytarabine(Ara⁃C)and granulocyte colony stimulating factor(G⁃CSF)]group,CAG regimen[aclarubicin(Acla)combined with Ara⁃C and G⁃CSF]group,and MAC regimen[mitoxantrone(MTZ)combined with cyclophosphamide(CTX)and Ara⁃C]group,with 40 cases in each group.The short⁃term efficacy,survival time and adverse reactions were compared among the three groups.Results The complete response(CR)rate of MAC regimen group was significantly higher than that of FLAG regimen group and CAG regimen group(52.50%vs.32.50%,35.00%,P<0.05),overall response rate(OR)was significantly higher than that of FLAG regimen group(65.00%vs.42.50%,P<0.05).There was no significant difference on partial response(PR)among the three groups(P>0.05).The overall survival(OS)of MAC regimen group was significantly higher than that of FLAG regimen group and CAG regimen group[32.6 months(2.0~47.5)vs.19.7 months(1.5~28.4),13.0 months(1.6~25.2),P<0.05].There was no significant difference on disease free survival(DFSP among the three groups(P>0.05).The incidence of infection of MAC regimen group and CAG regimen group was significantly higher than that of FLAG regimen group(82.50%,77.50%vs.50.00%,P<0.05).There was no significant difference on incidence of other adverse reactions among the three groups(P>0.05).Conclusions MAC regimen could significantly improve the short⁃term efficacy and survival time of AML patients after initial induction failure,while the incidence of infection was higher,but not serious adverse reactions,and the overall value was relatively higher than FLAG regimen and CAG regimen.