53例老年急性髓细胞白血病的疗效观察

目的：分析老年急性髓细胞白血病（AML）的临床特点和不同治疗方案的疗效。材料和方法：年龄≥60岁的老年AML患者53例，原发性AML44例和继发性AML9例，AML分别采用亚常规标准剂量蒽环类药物或高三尖杉酯碱联合阿糖胞苷（Ara-C)或小剂量的高三尖杉酯碱和Ara-C作为诱导方案，结果：发病时以发热和贫血症状最多见，以M5亚型常见，颅内出血是导致老年AML早期死亡的最常见的原因。急性髓细胞白血病（AML）总的完全缓解（CR）率43.4%，亚标准剂量方案治疗AML的CR率明显高于小剂量HA的疗效，但继发性AML患者无1例获CR。结论：对原发性AML老年患者尽可能地采用亚标准剂量的诱导治疗方案。

The Clinical Characteristics and Treatment Response of Acute Leukemia in the Elderly

Objective: To analyze the clinical characteristics and the response to treatment in older patients with acute leukemia retrospectively. Methods: Sixty patients older than 60 years with acute leukemia were admitted to our hospital. Forty-four patients had acute non-lymphocytic leukemia (ANLL). Seven patients had acute lymphocytic leukemia (ALL), and the remaining 9 cases were secondary ANLL. Patients with ANLL were treated with the standard combination of regimens with induced doses, consisting of anthracycline or homoharringtonine and cytosine arabinoside, or the low-dose of homoharringtonine or cytosine arabinoside respectively. Patients with ALL were given induction chemotherapy consisting of vincristine and prednisolone (VP), or VP plus adramycin and cyclophosphamide (CODP). Results: Fever and anemia symptoms at the presentation were the most common manifestation. ANLL-M 5 was a common subgroup in the elderly. The intracranial hemorrhage was the most common cause of early death. The overall rate of complete remission was 43.4%. The CR rate in the ANLL patients receiving substandard-dose regimens was significantly higher than those with the low-doses of HA. However, nine cases of the secondary ANLL were not observed to obtain CR. Conclusion: We prefer to select the substandard-dose regimen as an induction chemotherapy in the elderly with none acute leukemia.