老年慢性粒细胞性白血病临床治疗体会

目的通过比较联合化疗HA方案（高三尖杉酯碱,阿糖胞苷）,DA方案（柔红霉素,阿糖胞苷）与单药口服化疗（羟基脲,马利兰）治疗老年慢性粒细胞白血病（CML）的结果分析,探索适合老年患者的常规治疗方法。方法将25例CML老年患者随机分成两组（联合化疗组13例,单药口服化疗组12例）,分别应用以上方案进行化疗,比较两组的临床疗效,不良反应及长期存活状况。结果联合化疗组及单药口服化疗组首次血液学完全缓解（CR）分别为9例（占81.82%）、7例（占58.33%）,部分缓解（PR）2例（占18.18%）、5例（占41.67%）。两组均出现一定程度的骨髓抑制,但联合化疗组出现的早,持续时间长且较严重,联合化疗组患者死亡2例,1例死于严重感染,1例死于颅内出血。单药口服化疗组无死亡病例,费用也与联合化疗组相差悬殊。结论虽联合标准化疗治疗（也就是所说的慢粒急治）使老年CML患者获得首次化疗缓解率比单药化疗高,但单药化疗患者病情变化较平稳,化疗不良反应较少,从而对症、支持治疗少,花费明显较低,对于基层医院及老年患者来说仍应首先考虑。

Clinical Experience of Elderly Patients with Chronic Myelogenous Leukemia

Objective Through the comparison union chemotherapy HA plan （HHT base,Ara-C）,the DA plan （daunorubicin,cytarabine） with single agent oral chemotherapy （hydroxyurea,Maryland） treatment of elderly chronic myeloid leukemia （CML） results analysis,exploring the conventional treatment of elderly patients.Methods Totally 25 patients with CML in elderly patients were randomly divided into 2 groups （group of 13 patients with combination chemotherapy,single agent oral chemotherapy in 12 cases）,application of these programs were chemotherapy,compared two groups of clinical efficacy,adverse reactions and long-term survival of.Results The single-drug chemotherapy group and the first oral chemotherapy drug group hematological complete remission （CR） were 9 cases （81.82%）,7 cases （58.33%）,partial remission （PR） 2 cases （18.18% ）,5 cases （41.67%）.Group 2 suffered from some degree of bone marrow suppression,but the combined group appeared earlier,lasted longer and the more serious of the combined group of patients 2 died,1 died of severe infection,1 died of intracranial hemorrhage.Single-drug oral chemotherapy with no deaths,costs also are significant differences compared with the combined group.Conclusion Although combined with standard chemotherapy treatment （that is,acute treatment of chronic myeloid） to chemotherapy elderlyly chronic myeloid leukemia patients in first remission rate higher than the single drug chemotherapy,but the single-drug chemotherapy with more stable and less chemotherapy side effects,which symptomatic,supportive treatment less,significantly lower cost for the primary hospital and for elderly patients.