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作 者:钱思轩[1] 李建勇[1] 沈云峰[3] 蒋元强[3] 陆化[1] 吴汉新[1] 徐卫[1] 程蕴琳 盛瑞兰[1]
机构地区:[1]南京医科大学第一附属医院 江苏省人民医院血液科,210029 [2]南京医科大学第一附属医院 江苏省人民医院老年科,210029 [3]南京医科大学附属无锡医院血液科
出 处:《中华老年医学杂志》2007年第4期248-250,共3页Chinese Journal of Geriatrics
基 金:江苏省135工程医学重点人才资助项目(RC2002044)
摘 要:目的探讨小剂量阿糖胞苷(Ara-C,C)和阿克拉霉素(Acla,A)联合粒细胞集落刺激因子(G-CSF,G)治疗老年人急性髓细胞白血病(AML)的疗效和不良反应。方法回顾性分析60-81岁的AML患者52例,男28例,女24例。5例曾接受2个疗程正规剂量的化疗,均未缓解;40例作染色体核型分析,10例为预后不良染色体异常。52例均采用CAG预激方案治疗,即Acla 10mg/d,第1~8天,Ara-C10 mg/m^2,1次/12h,第1~14天,G-CSF200μg·m^-2·d^-1,第1~14天。结果化疗后总有效率69.2%,完全缓解(CR)率55.8%。初诊患者CR率为65.7%;复发、难治患者为35.2%;≥70岁患者为44.4%。10例预后不良染色体异常的患者完全缓解4例。全组早期病死率7.7%,总生存期中位时间14个月。化疗的不良反应主要为骨髓抑制,未见严重的非造血系统不良反应。结论CAG预激方案为治疗老年人AML的比较有效、安全的方案。Objective To evaluate the efficacy and toxicity for the protocol of low-dose cytarabine and aclarubicin in combination with granulocyte colony-stimulating factor (G-CSF) in elderly patients with acute myeloid leukemia (AML). Methods A total of fifty-two elderly patients with AML were enrolled. Twenty-eight patients were male, and 24 were female, with ages ranging from 60 to 81 years (median, 65 years). Complete remission (CR) had not been achieved in five patients after 2 courses of a standard induction regimen including daunorubicin and cytarabine or an equivalent anthracycline-based regimen. Cytogenetic analysis was performed in 40 patients, and unfavourable cytogenetic aberrations were found in 10 patients. All patients were treated with CAG regimen including low-dose cytarabine (10 mg/m^2 per 12 hours, day 1 to 14), aclarubicin (10 mg per day, day 1 to 8), and G-CSF priming (200 μg/m^2 per day, day 1 to 14). Results The overall response rate was 69.2%, and 29 of 52 (55.8%) patients achieved CR, including 23 of 35 (65.7%) patients with previously untreated AML, 6 of 17 (35.2%) patients with refractory, relapsed and secondary AML. Four of 9 (44. 4%) patients were aged over 70 years, 4 of 10 (40. 0%) patients with unfavourable cytogenetic aberrations reached CR. The early death rate was 7.7%. The median overall survival duration was 14 months. Myelosuppression was mild to moderate, no severe nonhematologic toxicity was observed. Conclusions CAG priming regimen as an induction therapy is well tolerable and effective in elderly patients with AML.
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