不同剂量阿糖胞苷维持治疗对老年急性髓系白血病预后的影响

目的 探讨不同剂量阿糖胞苷巩固维持治疗在老年急性髓系白血病(AML)患者的疗效及安全性.方法 北京军区总医院血液科2005年1月至2010年1月32例经过诱导化疗取得缓解的老年AML患者,完全随机分为治疗组A(12例)、治疗组B(10例)、治疗组C(10例).3组患者达到完全缓解后,分别给予不同剂量的单药阿糖胞苷(0.5g/次、0.5 g/m2及1.0 g/m2,静脉滴注,每12小时1次,第1～3天)维持巩固治疗,连续6～8个疗程,维持1～2年.结果 治疗组A、B和C患者治疗相关病死率为16.7％(2/12)、10.0％ (1/10)、20.0％ (2/10),复发相关病死率为41.7％ (5/12)、50.0％ (5/10)、40.0％ (4/10),中位生存期分别为15.8(5～60)、16.2(6～60)、15.7(6 ～60)个月,2年总生存率分别为41.7％、40.0％、40.0％.3组差异均无统计学意义(均P＞0.05).结论 不同剂量阿糖胞苷巩固维持治疗对老年AML患者的生存率无明显影响,在剂量增加的情况下治疗相关并发症增多,而总体长期生存率无提高.

Prognosis of the maintenance therapy with different doses of cytarabine in elderly patients with acute myelogenous leukemia

Objective To study the efficacy and safety of different doses of cytarabine maintenance therapy in elderly patients with acute myeloid leukemia （AML）. Methods Thirty-two cases achieved remission after induction chemotherapy in elderly patients with acute myeloid leukemia （AML）from January 2005 to January 2010 in General Hospital of Beijing Military Region. They were randomly divided into treatment group A （ n = 12）, the treatment group B （n = 10） and the treatment group C （n = 10）. After achieving complete remission, the patients in three groups were treated with different doses of a single drug （0. 5 g/Ara-C, 0. 5 g/m2 and 1 g/m2, intravenous injection） to maintain the consolidation therapy. The courses were 6 to 8 courses, maintaining for 1-2 years. Results Treatment-related mortality rate was 16.7% （2/12）, 10.0% （1/10） and 20.0% （2/10） in treatment group A, B and C. Relapse-related mortality was 41.7% （5/12）, 50.0% （5/10） and 40.0% （4/10） ;median survival was 15.8 （5-60） months, 16. 2 （ 6 -60 ） months and 15.7 （ 6 -60 ） months ; the 2 -year overall survival rate was 41.7%, 40. 0% and 40. 0%. Conclusions Maintenance therapy of different doses cytarabine in elderly patients with acute myeloid leukemia shows no significant survival differences. It increases dose treatment-related complications and does not increase the overall long-term survival rate.