老年人急性髓系白血病治疗研究进展

老年人急性髓系白血病(AML)的发病率逐年上升,平均发病年龄为67岁,由于老年患者易合并脏器功能不全,因此治疗尚无统一标准.文章结合第58届美国血液学会年会报道,对老年AML患者治疗方面的一些研究进展进行总结.     

小剂量及标准剂量化疗治疗老年人急性髓系白血病的疗效研究

 目的　评价小剂量、超小剂量化疗及标准剂量化疗治疗老年人急性髓系白血病（AML）的疗效,寻找小剂量化疗的适应证。方法　回顾性分析1993年1月至2008年11月收治的77例≥60岁AML患者的病例资料,分析小剂量、超小剂量和标准剂量化疗的近期和远期疗效。结果　总样本中小剂量、超小剂量组患者的年龄较大、PS评分较高、白细胞较低,但与标准剂量组比,完全缓解（CR）率、总有效率（ORR）、无事件生存率（EFS）和总生存率（OS）差异均无统计学意义。按照年龄或PS评分细分亚组,小剂量、超小剂量组在＜70岁和PS评分≤2的亚组中,不论近期、远期疗效都明显优于标准剂量组;而在＞70岁和PS评分＞2的亚组中,两组疗效差异无统计学意义。进一步分析显示：小剂量化疗并未降低化疗相关死亡,也未增加远期复发的风险。结论　小剂量、超小剂量化疗与标准剂量化疗相比可以改善老年人AML患者的预后,而且更适用于年龄较轻、一般情况较好的部分老年患者。     

减低剂量FLAG方案治疗老年人复发急性髓系白血病疗效观察

  目的　探讨减低剂量FLAG方案治疗老年人复发急性髓系白血病（AML）的疗效、不良反应。方法　对20例老年复发AML患者,随机分两组,10例采用减低剂量FLAG方案化疗,10例采用常规剂量FLAG方案化疗,比较其疗效和不良反应。结果　减低剂量FLAG方案组10例1个疗程完全缓解（CR）3例,部分缓解（PR）3例,未缓解（NR）4例,总有效（OR）率60.0 %。常规剂量FLAG方案组10例1个疗程CR 3例,PR 3例,NR 4例,其中1例死于感染,OR率60.0 %。两组不良反应均为骨髓抑制、发热和感染,而消化道症状和肝损害轻微,未见蒽环类心毒性,化疗中无因并发症死亡的病例。结论　减低剂量FLAG方案组CR率及OR率接近于常规剂量FLAG方案组,不良反应较常规剂量组发生率低,是老年复发AML患者治疗的较好选择。     

小剂量MA联合G-CSF治疗老年人急性髓系白血病13例

目的观察小剂量长疗程MAG方案治疗老年人急性髓系白血病（AML）的疗效。方法AML患者13例,给予米托蒽醌每天2～5mg／m^2,第1天至第7天,每次阿糖胞苷10mg／m^2,皮下注射,1次／12h．第1天至第14天,150～300ug／d,皮下注射液,同时加强支持。结果一个疗程完全缓解（CR）4例（30．77％）,二个疗程CR2例（15．38％）,部分缓解（PR）2例（15．88％）,总有效率61．53％,中位生存时间282（34～478）d。结论老年人AML仍应给予积极的治疗,小剂量长疗程的MAG方案可能是较理想的选择,同时应予足够支持治疗。     

地西他滨联合半量CAG和单用CAG方案治疗老年人急性髓系白血病效果比较

目的 探讨地西他滨联合半量CAG方案和单用CAG方案治疗老年人急性髓系白血病(AML)的疗效及不良反应.方法 回顾性分析山东省菏泽市立医院2013年8月至2017年8月收治的42例老年AML患者(急性早幼粒细胞白血病除外)临床资料,患者年龄65～75岁.根据化疗方案分为治疗组和对照组,治疗组20例采用地西他滨联合半量CAG方案(重组粒细胞集落刺激因子+阿糖胞苷+阿柔比星),对照组22例单用CAG方案.结果 1个疗程后治疗组患者完全缓解(CR) 13例,部分缓解(PR)3例,未缓解(NR)4例,总有效(CR+PR)率为80.0％(16/20);对照组CR 8例,PR 2例,NR 12例,总有效率为45.5％(10/22),两组总有效率比较差异有统计学意义(x2=3.707,P=0.035).两组骨髓恢复时间、输注红细胞及血小板量比较,差异均无统计学意义(均P＞ 0.05).结论 地西他滨联合半量CAG方案治疗老年AML患者的效果优于单用CAG方案,不良反应均可耐受,可作为老年人AML的首选治疗方案.     

CTG方案联合HA和IA方案序贯诱导治疗老年人急性髓系白血病36例

 【摘要】　目的　探讨CTG方案（粒细胞集落刺激因子、吡柔比星、阿糖胞苷）联合HA方案（高三尖杉酯碱、阿糖胞苷）和IA方案（去甲氧柔红霉素、阿糖胞苷）治疗老年急性髓系白血病（AML）的疗效和安全性。方法　对36例老年AML患者用CTG方案联合HA和IA方案序贯诱导治疗。结果　36例老年AML患者接受本方案治疗完全缓解12例（33.3 ％）,部分缓解14例（38.7 ％）,未缓解8例（22.2 %）。结论　CTG方案联合HA和IA方案序贯诱导治疗老年人AML安全有效。     

老年人急性髓系白血病治疗进展：第57届美国血液学会年会报道

老年人急性髓系白血病（AML）占所有AML患者的35%,且发病率逐年上升,平均发病年龄为67岁。一般AML患者要求进行强烈化疗,但老年患者常由于脏器功能不全而不能耐受强烈化疗,目前临床上仍缺乏统一的治疗措施。第57届美国血液学会年会关于老年人AML的研究包含多个领域,传统的诱导化疗、去甲基化药物单用或联用其他药物、新型药物的采用均有涉及,文章对其进行总结。     

阿扎胞苷治疗老年人急性髓系白血病的研究进展

阿扎胞苷是一种新型去甲基化抗肿瘤药物,国外临床研究认为阿扎胞苷对于身体状况较差、不能耐受常规化疗的老年急性髓系白血病(AML)患者的治疗可能是一种毒副作用小的有效治疗手段.文章就阿扎胞苷治疗老年人AML的研究进展进行综述.     

老年急性髓系白血病治疗的研究进展

目的:总结国内外老年急性髓系白血病(AML)的治疗现状,探讨传统化疗、造血干细胞移植及新药在老年AML治疗中的应用.方法:应用Med-line及PubMed全文数据库检索系统,以"老年、急性髓系白血病、治疗"等为关键词,检索 2004-01-2011-06的相关文献.纳入标准:1)传统化疗在老年AML治疗中应用；2)老...     

Double intensive consolidation chemotherapy in adult acute myeloid leukemia

Of 115 adult patients with de novo acute myeloid leukemia (AML), 87 (75.5%) achieved complete remission (CR) after induction treatment with zorubicin and conventional doses of cytarabine (Ara-C). Patients under age 45 years with histocompatibility locus antigen-identical sibling underwent bone marrow transplantation (BMT). The others were treated with two courses of intensive consolidation chemotherapy (ICC): course 1 with 4 days of high-dose Ara-C and 3 days of amsacrine (m-AMSA); course 2 with carmustine (BCNU), Ara-C, cyclophosphamide, and etoposide. Forty-two patients received both planned courses, 15 received only the first, and 13 patients could only support conventional maintenance therapy. Four patients died during consolidation. With a median follow-up of 60 months, the disease-free survival (DFS) after ICC at 5 years is 40.3% (+/- 6.5%), with no statistically significant difference between patients receiving one or two courses. The DFS for the 17 transplanted patients is comparable (P = .72) and is lower for the 13 excluded patients (23% +/- 11.5%, P = .046). Age did not influence the probability of remaining in CR. In univariate analysis, three parameters had a negative impact on the 5-year DFS: a high initial WBC count (52% for patients with less than 30 x 10(9) WBC/L v 12% for patients with greater than 30 x 10(9) WBC/L, P = .01), a long delay between induction treatment and course 1 (+/- 60 days; 63% v 29%, P = .01), and a long delay between course 1 and course 2 (+/- 60 days, 61.5% v 28.5%, P = .05). In multivariate analysis (Cox model), only the WBC count remained significant. This study confirms the value of intensive postremission chemotherapy, which can be compared in AML with allogeneic or autologous BMT. It also demonstrates the prognostic value of the initial WBC count. The optimal modalities of ICC remain to be defined by further studies.     

大剂量阿糖胞苷强化疗对急性髓性白血病长期生存的影响

目的探讨应用大剂量阿糖胞苷治疗缓解后急性髓细胞白血病（AML）的疗效及安全性。方法采用回顾性分析方法,对初次治疗完全缓解的AML患者给予4个大剂量阿糖胞苷强化化疗,治疗后对长期存活者进行随访观察。结果24例患者中存活2年以上者15例（62．5％）,其中8例（33．3％）已无病生存5年以上。结论大剂量阿糖胞苷强化疗安全有效,是AML患者获得长期无病生存的重要治疗方法,其治疗效果值得更大规模临床应用。     

Prognostic features for response and survival in elderly patients with de novo acute myeloid leukemia treated with mitoxantrone and intermediate dose cytarabine

Forty-three fit elderly patients with de novo acute myeloid leukemia (AML) received chemotherapy with mitoxantrone and intermediate dose cytarabine (MIDAC) in a phase II clinical trial conducted by the Australasian Leukaemia and Lymphoma Group. The main aim of the study was to evaluate the tolerability and efficacy of MIDAC in inducing durable remissions. While the chemotherapy was generally well tolerated, less than half the patients achieved complete remission (CR) after induction and many of those in CR could not receive planned consolidation cycles. The median overall survival for all patients was 6.5 months and the median disease-free survival for those achieving CR was 8.3 months. Only 2 patients survived beyond 4 years. Factors significantly associated with shorter survival were adverse cytogenetics, marrow dysplasia and increasing age. These results suggest that only selected elderly patients with AML are likely to benefit from aggressive chemotherapy and that novel therapies are required to improve the poor prognosis of this group.     

老年急性髓细胞白血病的临床特点

根据老年急性髓细胞白血病的临床特点,寻求治疗老年急性髓细胞性白血病的有效措施。回顾性分析25例老年急性髓细胞白血病的临床资料,治疗按个体差异分为姑息治疗组、小剂量HA化疗组及标准剂量联合化疗组,并对其治疗效果进行比较。老年急性髓细胞白血病,具有独特的生物学及临床特征;姑息治疗组3例,CR率为0;小剂量HA化疗组7例,CR率28.6%;标准剂量联合化疗组15例,CR率33.3%。标准剂量联合化疗组的CR率及平均存活期均高于小剂量HA化疗组,而诱导期死亡率则低于小剂量HA化疗组,但其差异均无统计学意义。对老年急性髓细胞性白血病的化学治疗应个体化,并辅以积极的综合治疗,才能有望提高疗效。     

Attitude towards remission induction for elderly patients with acute myeloid leukemia influences survival.

Combination chemotherapy may induce remission from acute myeloid leukemia (AML), but validated criteria for treatment of elderly are lacking. The remission intention (RI) rate for elderly patients, as reported to the Swedish Leukemia Registry, was known to be different when comparing the six health care regions, but the consequences of different management are unknown. The Leukemia Registry, containing 1672 AML patients diagnosed between 1997 and 2001, with 98% coverage and a median follow-up of 4 years, was completed with data from the compulsory cancer and population registries. Among 506 treated and untreated patients aged 70-79 years with AML (non-APL), there was a direct correlation between the RI rate in each health region (range 36-76%) and the two-year overall survival, with no censored observations (6-21%) (chi-squared for trend=11.3, P<0.001; r2=0.86, P<0.02, nonparametric). A 1-month landmark analysis showed significantly better survival in regions with higher RI rates (P=0.003). Differences could not be explained by demographics, and was found in both de novo and secondary leukemias. The 5-year survival of the overall population aged 70-79 years was similar between the regions. Survival of 70-79-year-old AML patients is better in regions where more elderly patients are judged eligible for remission induction.