小剂量高三尖杉酯碱+阿糖胞苷方案诱导治疗不同危险度分层急性髓系白血病效果分析

目的 探讨小剂量(LD)-高三尖杉酯碱+阿糖胞苷(HA)方案诱导治疗急性髓系白血病(AML)(除外M3)的临床效果.方法 对52例接受LD-HA方案诱导治疗的AML患者资料进行回顾性分析,并依据分子生物学和细胞遗传学危险度分级,观察临床疗效、不良反应,随访长期生存,以同期49例伊达比星+阿糖胞苷(IA)方案治疗患者为对照.结果 1个疗程后,LD-HA组总有效(OR)率为71.2%(37/52)[完全缓解(CR)率50.0%(26/52),部分缓解(PR)率21.2%(11/52)],IA组OR率为53.1%(26/49)[CR率44.9%(22/49),PR率8.2%(4/49)],两组OR率差异无统计学意义(P=0.068).按危险度分层,LD-HA组高危组的OR率高于IA组[100%(11/11)比66.7%(12/18)],差异有统计学意义(P<0.05);LD-HA组和IA组的低危组和中危组OR率差异无统计学意义(P>0.05).LD-HA组心脏毒性及骨髓抑制均较IA组轻,不适合标准方案的AML患者亦对其耐受良好.结论 LD-HA方案诱导治疗AML时,高危组OR率高,化疗相关不良反应发生率低,安全性较高.与标准方案相比,LD-HA对于高危AML患者可能更有效.

Efficacy of low-dose cytarabine and harringtonine regimen as induction in different risk stratifications of acute myeloid leukemia

Objective To explore the clinical efficacy of low-dose cytarabine and harringtonine (LD-HA) regimen in the induction therapy of acute myeloid leukemia (AML) except M3. Methods 52 AML patients who received LD-HA were analyzed retrospectively. The patients were graded according to molecular biological and cytogenetic risk degree. The clinical efficacy, toxicity of LD-HA and long-term survival followed-up were compared with those of idarubicin and cytarabine (IA) regimen in 49 patients. Results After one cycle, the overall remission (OR) rates of LD-HA group and IA group were 71.2%(37/52) [CR rate 50.0%(26/52), PR rate 21.2%(11/52)] and 53.1%(26/49) [CR rate 44.9%(22/49), PR rate 8.2%(4/49)], respectively, with no statistical significance of OR between the two groups (P= 0.068). OR rates were not statistically significant in either low-risk group or intermediate-risk group between LD-HA group and IA group (P> 0.05), but OR of high-risk group in LD-HA was much higher than that in IA group [100 % (11/11) vs 66.7 % (12/18), P<0.05]. Cardiac toxicity and bone marrow suppression in LD-HA group were much milder than those in IA group. The patients unfit for standard chemotherapy could tolerate to LD-HA regimen. Conclusions LD-HA regimen as induction for high risk AML patients can improve the OR rate, and reduce the side effects, which is beneficial for high-risk AML patients.