去甲氧柔红霉素联合大剂量阿糖胞苷巩固治疗首次缓解的老年急性髓系白血病的疗效分析

A Retrospective Study on the Efficacy and Safety of Idarubicin Combined with High-Dose Cytarabine Consolidation in Patients with Acute Myeloid Leukemia over 60 Years of Age in First Remission

目的:评估去甲氧柔红霉素联合大剂量阿糖胞苷作为老年急性髓系白血病(AML)患者缓解后治疗方案的疗效及安全性。方法:对2017年11月至2021年6月纳入的24例年龄≥60岁的初次诱导缓解的AML患者进行去甲氧柔红霉素联合大剂量阿糖胞苷的巩固化疗(去甲氧柔红霉素10 mg/m^(2),1次d1,静脉滴注;阿糖胞苷1.5 g/m^(2),q12h,静脉滴注持续3 h,d1-3),观察疗效及安全性。结果:24例患者中,男性12例,女性12例,中位年龄65(60-78)岁,中位随访时间为23.3(2-42.7)个月。至随访结点时,共有15例患者复发,11例患者死亡,中位无病生存期为9个月,2年无病生存3例,中位总生存期16.2个月,2年总生存4例。在安全性方面,有6例患者出现1-2级的非血液学不良反应,12例患者出现3-4级血液学不良反应,24例患者中共有6例患者在巩固化疗后出现感染。多因素分析结果显示,2个诱导疗程及遗传学风险高危是本次研究中老年AML患者无病生存期及总生存期的不利因素。结论:对于年龄≥60岁的AML患者,去甲氧柔红霉素联合大剂量阿糖胞苷作为首次缓解后的治疗方案具有较好的安全性,但是疗效与既往其他方案相当,该治疗方案仍需进一步探索。

Objective:To evaluate the efficacy and safety of idarubicin combined with high-dose cytarabine as a postremission therapy for elderly patients with acute myeloid leukemia (AML).Methods:From November 2017 to June2021,24 AML patients aged≥60 years who were in complete remission for the first time were enrolled in consolidation chemotherapy with idarubicin (10 mg/m~2 intravenously once for day 1) combined with high-dose cytarabine (1.5 g/m~2 intravenously over 3 hours every 12 hours for day 1-3),and the efficacy and safety were observed.Results:Among the24 patients,there were 12 males and 12 females,the median age was 65 (60-78) years old,and the median follow-up time was 23.3 (2-42.7) months.By the end of the follow-up,15 patients relapsed and 11 patients died.The median disease-free survival (DFS) was 9 months and there were 3 cases of 2-year DFS.The median overall survival (OS) was 16.2 months,and there were 4 cases of 2-year OS.In terms of safety,6 patients had grade 1-2 non-hematological adverse reactions,12patients had grade 3-4 hematological adverse reactions,and a total of 6 patients developed infection after consolidation chemotherapy.Multivariate analysis showed that two induction cycles and high-risk cytogenetic abnormalities were the adverse factors of DFS and OS in elderly patients with AML in this study.Conclusion:For AML patients≥60 years old in first complete remission,idarubicin combined with high-dose cytarabine as post-remission therapy has a better safety,but compared with other regimens does not improve the prognosis of elderly patients,which needs further exploration.