HAA方案诱导治疗初治及复发、难治急性髓系白血病临床分析

  目的　探讨HAA方案诱导治疗初治及复发、难治急性髓系白血病（AML）的疗效和安全性。方法　回顾性分析行HAA方案治疗的66例AML患者的资料，按临床病理因素进行分层分析，观察疗效及不良反应情况。结果　66例患者中初治AML 45例，可评价疗效41例，诱导化疗后36例完全缓解，1例部分缓解，总有效率为90.2 %（37／41）；难治复发AML 21例，其中9例获得完全缓解，有效率为42.9 %（9／21）。HAA方案在性别、年龄、入院时白细胞数目和疾病亚型各分层内缓解率差异无统计学意义（均P＞0.05）。14例初治完全缓解病例随访2～19个月，中位随访10个月，持续缓解中位时间为9个月（2～17个月），其中5例（35.7 %）巩固化疗期间复发。HAA方案的骨髓抑制中位时间为14 d（3～23 d）。主要不良反应为不同程度的恶心、呕吐20 %（13／66）]，腹痛、腹泻9 %（6／66）]及化疗相关感染53 %（35／66）]，未见其他严重的非血液学不良反应。结论　HAA方案对于初治及复发、难治AML均能获得较高的有效率，且安全性较好。

Clinical analysis of HAA induction regimen for newly diagnosed and refractory relapsed acute myeloid leukemia

Objective　To analyze the efficacy and safety of HAA induction regimen consisted of homoharringtonine (HHT), cytarabine (Ara-C) and aclacinomycin (ACM) in naive and refractory relapsed acute myeloid leukemia. Methods　Data from 66 acute myeloid leukemia (AML) cases hospitalized and treated with HAA induction regimen was analyzed retrospectively. Results　45 of the 66 cases suffered from naive AML, and 21 were refractory relapsed. HAA efficacy in naive AML was evaluated in 41 cases with 36 in complete remission (CR) and 1 in partial remission (PR). The efficiency of HAA induction regimen was 90.2 % (37/41) in naive AML group and 42.9 % (9/21) in refractory relapsed group, respectively. There were no differences (P > 0.05) when considering patient's gender, age, disease subtype and white blood cell count at onset. 14 patients in CR with naive AML were followed-up for a median time of 9 months (2-17 months), and 5 cases relapsed (35.7 %) in a range of 2-8 months. The median myelosuppression period was 14 days (3-23 days). Nausea and vomiting 20 % (13/66)] were the major side effects of HAA regimen, and the other side effects were abdominal pain and diarrhea 9 % (6/66). After chemotherapy, 53 % (35/66) of the cases experienced infection/fever due to neutropenia. Other severe non-hematological side effects did not occur. Conclusion　HAA regimen may be an ideal choice for the induction chemotherapy of naive and relapsed refractory AML.