Easily manageable prognostic factors in 152 Chinese elderly acute myeloid leukemia patients:a single-center retrospective study

We retrospectively investigated the prognostic factors of acute myeloid leukemia（AML） in 152 Chinese patients with de novo AML who were older than 60 years of age and who received treatment at our hospital.Log-rank test showed that 6 parameters including older age,higher white blood cell（WBC） counts,lactate dehydrogenase（LDH）and bone marrow（BM） blasts at diagnosis,unfavorable risk cytogenetics,and non-mutated CEBPα were significant adverse prognostic factors of overall survival（OS） for elderly AML patients（P = 0.0013,0.0358,0.0132,0.0242,0.0236 and 0.0130,respectively）.Moreover,older age and higher LDH were significant adverse predictors for relapse-free survival（RFS）（P = 0.0447 and 0.0470,respectively）.Univariate analysis revealed similar results for OS to those of the log-rank test and only higher LDH at diagnosis was a significant adverse predictor for RFS（P = 0.028,HR：1.979,95%CI：1.075-3.644）.In multivariate analysis,we identified 2 trends towards independent prognostic factors for OS,including BM blasts at diagnosis（P = 0.057,HR：1.676,95%CI：0.984-2.854）and mutation status of CEBPα（P = 0.064,HR：4.173,95%CI：0.918-18.966）.Our data indicated that older age,gender and a previous history of hematologic diseases resulted in lower complete remission rate（P = 0.012,0.051 and 0.086,respectively）.We further developed an easy scoring system for predicting prognosis and response to induction therapy in older AML patients.Patients who had lower scores showed significantly longer OS and RFS（P = 0.0006 and 0.1001,respectively） and higher CR rate（P = 0.014）.Our research is limited by its retrospective nature and the results from our study need to be further validated by prospective randomized clinical trials.

A phase Ⅳ study of homoharringtonine, cytarabine, aclacinomycin and G-CSF(HCAG) regimen compared with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia patients

Objective · To compare the efficacy and prognostic factors of HCAG regimen with traditional IA regimen in the treatment of newly diagnosed elderly acute myeloid leukemia(AML) patients. Methods · Forty-one patients with AML(aged 55-71 years) were randomly divided into two groups(Group HCAG and Group IA) between 2014 and 2016 for induction and consolidation therapy. Multivariate analysis was applied to identify prognostic factors for relapse-free survival(RFS). Results · A total of 29 patients(70.7%) achieved complete remission(CR). The estimated 2-year overall survival(OS) was 66.8% in Group HCAG and 75.4% in Group IA(P=0.913). The estimated 2-year RFS was 61.8% in Group HCAG and 49.1% in Group IA(P=0.411). Age remained as the unfavorable prognostic factor, leading to significant differences in OS and RFS. In addition, RFS was influenced by cytogenetic/molecular risk stratification. Conclusion · Although HCAG seemed not to particularly benefit the group, the dose reduction of anthracyclines may be applied in elderly patients with comparable short-time outcome. Furthermore, the introduction of homoharringtonine resulted in an improvement of treatment response for more than 20% compared with CAG regimen.

Arsenic-Containing Qinghuang Powder(青黄散)Is An Alternative Treatment for Elderly Acute Myeloid Leukemia Patients Refusing Low-Intensity Chemotherapy

Objective:To analyze the overall survival(OS)of elderly acute myeloid leukemia(AML)patients treated with oral arsenic-containing Qinghuang Powder(青黄散,QHP)or low-intensity chemotherapy(LIC).Methods:Forty-two elderly AML patients treated with intravenous or subcutaneous LIC(1 month for each course,at least 3 courses)or oral QHP(3 months for each course,at least 2 courses)were retrospectively analyzed from January 2015 to December 2017.The main endpoints of analysis were OS and 1-,2-,3-year OS rates of patients,respectively.And the adverse reactions induding bone marrow suppression,digestive tract discomfort and myocardia injury were observed.Results:Out of 42 elderly AML patients,22 received LIC treatment and 20 received QHP treatment,according to patients'preference.There was no significant difference on OS between LIC and QHP patients(13.0 months vs.13.5 months,P>0.05).There was no significant difference on OS rates between LIC and QHP groups at 1 year(59.1%vs.70.0%),2 years(13.6%vs.15%),and 3 years(4.6%vs.5.0%,all P>0.05).Furthermore,there was no significant difference of OS on prognosis stratification of performance status>2(12 months vs.12 months),age>75 year-old(12.0 months vs.12.5 months),hematopoietic stem cell transplant comorbidity index>2(12 months vs.13 months),poor cytogenetics(12 months vs.8 months),and diagnosis of secondary AML(10 months vs.14 months)between LIC and QHP patients(P>0.05).Conclusion:QHP may be an alternative treatment for elderly AML patients refusing LIC therapy.

地西他滨联合CAG或HAAG方案治疗老年白血病疗效比较

目的:观察地西他滨(DAC)+CAG方案与地西他滨(DAC)+HAAG方案治疗初治老年急性非淋巴细胞白血病(AML)的疗效与安全。方法:回顾性分析我院血液科近5年的58例老年初治急性非淋巴细胞白血病患者,其中35例接受DAC+CAG方案诱导化疗,23例接受DAC+HAAG方案诱导化疗。结果:DAC+CAG及DAC+HAAG组缓解率分别为51.4%及60.9%,差异无统计学意义(P=0.592),两组有效率分别为62.9%及69.6%,差异无统计学意义(P=0.779)。经过平均12个月(1~60个月)的随访,两组的2年存活率分别为23.5%及33.3%,差异无统计学意义(P=0.591)。结论:DAC+CAG与DAC+HAAG方案对于诱导老年急性非淋巴细胞白血病缓解的疗效差异并不明显,两种方案对患者的长期生存并无明显影响。

去甲基化治疗中高危骨髓增生异常综合征和老年急性髓系白血病的疗效观察

目的探讨老年急性髓系白血病（AML）和中高危骨髓增生异常综合征（MDS）采用去甲基化药物治疗的临床效果。方法选择驻马店市中心医院2012年1月至2014年3月收治的中高危骨髓增生异常综合征和老年急性髓系白血病患者共16例，均采用去甲基化药物地西他滨治疗，回顾其临床资料。结果16例中完全缓解3例，部分缓解1例，病情稳定7例，病情进展1例，死亡4例。疾病控制11例，控制率为68．8％，生存期为（11．6±2．2）个月。观察不良反应，5d剂量组Ⅲ～Ⅳ度骨髓抑制伴发热、肺部感染率低于3d剂量组（P〈0．05）。并发出血3例，乏力5例，轻度呕吐、恶心2例，轻度腹泻2例。结论针对中高危MDS和老年急性髓系白血病患者，除应用最理想的对症支持治疗外，地西他滨可作为一个新的治疗手段，效果更佳，支持治疗更为显著，可使死亡时间及MDS发展为AML的时间延缓，增加疗程数。观察血液学不良反应，以感染和Ⅲ～Ⅳ度骨髓抑制最多见。治疗过程中需加强输血及抗感染治疗，以从整体上改善预后，保障患者的生存质量。