减低剂量的DA方案诱导治疗初治急性髓细胞白血病的临床疗效研究

目的 探讨含不同剂量柔红霉素的DA(柔红霉素+阿糖胞苷)方案诱导治疗初治急性髓细胞白血病的临床疗效观察.方法 前瞻性研究分析我省多个医疗研究中心2013年8月至2016年11月住院确诊的初治急性髓细胞白血病76例患者的临床资料,分为A组、B组及C组,观察三组患者治疗后完全缓解(CR)率及生存期.结果 入组A组患者12例,B组患者54例,C组患者10例.首次诱导治疗后A组有效率83.33%,CR率66.67%;B组有效率 92.60%,CR率 83.33%;C组有效率 90.00%,CR率80.00%.第二疗程评估共73例:A组有效率83.33%,CR率83.33%;B组有效率90.74%,CR率 88.87%;C组有效率 85.71%,CR率85.71%,C组患者3例中1例患者死亡,另2例患者自请出院.6个周期疗程治疗的可评估病例共51例,A组6例,B组42例,C组3例,OS率A组100%,B组92.86%,C组100%;随访1年,共45例,1年总生存(OS)82.22%,无进展生存期(PFS)64.44%;2年总OS 74.36%,PFS 61.54%.结论 减低剂量柔红霉素的DA方案诱导治疗初治急性髓系白血病有效,与高剂量相比毒副作用较低,适用于老年、体能状态差、有合并症及经济条件差的患者,但减低剂量方案治疗疾病易进展,不常规推荐使用.

Observation on clinical outcome of primary acute myeloid leukemia which inducedby treated with reduced-dose DA regimen

Objective To probe clinical outcome of acute myeloid leukemia which induced by treated with DA (Daunorubicin+Cytarabine) regimen contained with different dose of daunorubicin.Methods Retrospective analysis of 76 patients with acute myeloid leukemia of multiple medical research centre in our province from August 2013 to November 2016,which were divided into A group,B group and C group.Observation on the complete remission (CR) rate and survival rate of three groups after treatment.Results There were 12 patients in group A,54 patients in group B,and 10 patients in group C.After the first induced treatment,effective rate was 83.33%,CR rate was 66.67% in group A,effective rate was 92.60%,CR rate was 83.33% in group B,effective rate was 90.00%,CR rate was 80.00% in group C.73 patients were evaluated in the second course of treatment,effective rate was 83.33%,CR rate was 83.33% in group A,effective rate was 90.74%,CR rate was 88.87% in group B,effective rate was 85.71%,CR rate was 85.71% in group C.51 patients were evaluated after six courses of treatment,6 patients in group A,42 patients in group B,3 patients in group C,OS rate was 100%,92.86% and 100% in group A,group B and group C respectively.1-year total OS rate and PFS was 82.22% and 64.44% respectively after follow-up of 1 year with 45 patients,2-year total OS rate and PFS was 74.36% and 61.54% respectively after follow-up of 2 years.Conclusion It is effective treatment in primary acute myeloid leukemia which induced by treated with reduced-dose DA regimen.It is low toxicity and applicable to the elderly,poor physical condition,complications and poor economic condition patients compared with the higher dose,but it not routinely recommended because disease easy to progress after reduced-dose treated.