IA方案继以FLAG方案巩固治疗原发性急性髓系白血病疗效观察

目的 探讨标准剂量的IA方案诱导治疗,继以FLAG方案巩同治疗原发急性髓系白血病(AML)的疗效、不良反应及对造血干细胞采集的影响.方法 2004年5月至2008年1月收治的23例初治AML患者,染色体核型分析采用R显带技术.诱导方案为IA:去甲氧柔红霉素(IDA)12 mg·m-2·d-1,第1～3天,阿糖胞苷(Ara-C)100 mg·m-2·d-1,持续静脉点滴,第1～7天.继以FLAG方案巩固治疗,即氟达拉滨(Flud)50 mg/d,第1～5天;Ara-C 2 g·m-2·d-1,第1～5天;G-CSF 300μg/d,皮下注射,化疗前1天至第5天.结果 1个疗程结束后完全缓解(CR)率为91.3%.良好和中等预后核型患者的CR率分别为100%和91.3%.19例CR患者继之采用FLAG方案巩固治疗,9例患者在FLAG方案1～3个疗程后进行自体干细胞采集,其中6例(66.7%)采集到足够的自体造血干细胞.4例AML患者复发,23例患者中位生存期19.5个月,中位无病生存期为14个月.IA和FLAG方案化疗的不良反应主要为骨髓抑制和粒细胞缺乏所致感染,未见严重的非造血系统不良反应.结论 标准剂量的IA方案诱导继以FLAG方案巩同治疗AML疗效肯定,尤其对于良好和中等预后的AML患者.不良反应主要是骨髓抑制,1～2个疗程FLAG方案对造血干细胞可能无明显影响.

Efficacy of IA regimen followed by FLAG regimen in the treatment of acute myeloid leukaemia

Objective To investigate the efficacy and toxicity of standard-dose IA regimen (idarubi-cin and cytarabine) as induction therapy followed by FLAG regimen in patients with acute myeioid leukemia (AML), and its influence on peripheral stem cell mobilization. Methods A total of 23 previously untreated de novo AML patients were enrolled. Thirteen patients were male, and 10 female, with ages ranging from 14 to 54 (median: 41) years. Cytogenetic analysis was performed for all patients. The IA regimen contained ida-rubicin (12 mg·m-2·d-1, days 1 to 3) and cytarabine (100 mg·m-2·d-1, days 1 to 7), and the FLAG regimen contained fludarabine (50 mg/d, days 1 to 5), cytarabine (mg·m-2·d-1, days 1 to 5) and granulocyte colony-stimulating factor (G-CSF, 300 μg/d, days 0 to 5). Results After one course of in-duction therapy, the CR rate was 91.3%. The CR rate for patients with favourable and intermediate prognos-tic karyotypes was 100% and 91.3%, respectively. Nineteen patients in CR were consolidated with FLAG regimen, of which 6/9 (66.7%) patients were able to mobilize a sufficient number of CD34+ cells and suc-cessfully performed autologous stem cell transplantation. Four patients relapsed. The median survival duration was 19.5 months and median disease-free survival was 14 months. Myelosuppression and infections due to neutropenia were the most frequent adverse effects, severe nonhematologic toxicity and the early death were not observed in all patients. Conclusion IA followed by FLAG regimen is effective and well tolerable in AML patients especially in those with favourable and intermediate prognostic karyotypes, and 1 to 2 courses of this therapy shows no influence on peripheral stem cell mobilization and subsequent autologous stem cell trans-plantation.