含高三尖杉酯碱方案治疗初治急性髓系白血病46例效果和生存分析

目的探讨以高三尖杉酯碱（HHT）为主的化疗方案治疗急性髓系白血病（AML）的缓解率，评价AML不同染色体核型、基因突变对总生存（OS）率、无事件生存（EFS）率的影响。方法将80例初治AML患者用随机信封法分为HAA、HDA、DA、IA方案治疗组，比较各组诱导完全缓解（CR）率，并将AML患者分为染色体核型“好、中、差”三组，分别比较OS、EFS。结合患者是否表达预后较差的基因突变，利用染色体与基因型两者总体评价OS、EFS。结果用含有HHT方案治疗初治AML46例，总CR率78．3％（36／46），高于DA方案组总CR率66．7％（10／15）及IA方案组的63．2％（12／19），三种方案组CR率差异无统计学意义（P〉0．05）。不同染色体核型对于生存具有较大影响，染色体核型“差”者OS、EFS较染色体核型“好”或“中”者下降程度显著。结合染色体和基因型分组对于显示预后总体OS、EFS的下降趋势更明显。结论含HHT的治疗方案CR率与传统DA、IA方案相似，提示高三尖杉酯碱治疗的有效性。不同染色体及基因突变对于AML预后具有较大影响。

Prognosis and efficacy of homoharringtonine-based chemotherapy on 46 de novo acute myeloid leukemia patients

Objective To investigate the remission rate of acute myeloid leukemia （AML） patients after treatment with homoharringtonine （HHT）-based chemotherapy and evaluate the influence of karyotype and genetic mutation on overall survival （OS） and event free survival （EFS）. Methods 80 de novo AML during Jan 2008 and Apt 2010 were collected. These patients were randomized into HAA, HDA, DA, IA, and were compared on complete remission （CR）. They were also grouped as ＂good, median, bad＂ karyotype and also compared on OS and EFS until Feb 2013. In the meantime, the combined effects of karyotype and gene mutation on OS and EFS were also analyzed. Results 46 cases were treated by HHT-based induction therapy, in which CR rate was 78.3 % （36/46） and higher than 66.7 % （10/15） of DA and 63.2 % （12/19） of IA. But there was no difference between different groups （P 〉 0.05）. However, karyotype imposed great effect on OR in that the worse type had lower OS and EFS. And this trend was even more obvious when considering combination of karyotype and genotype. Conclusions HHT-based induction therapy has similar CR with DA and IA in treating AMLc, which indicating that homoharringtonine is very effective chemotherapeutic agent for AML. In addition, karyotype and genotype have greater effect on prognosis of AML after HHT-based chemotherapy.