高危骨髓增生异常综合征及急性髓系白血病治疗方案选择研究  

Effects of Idarubicin and cytosine arabinoside on high-risk myelodysplastic syndromes and acute myeloid leukemia

作　　者：刘惠[1] 付蓉[1] 邵宗鸿[1] 阮二宝[1] 王晓明[1] 王国锦[1] 梁勇[1] 瞿文[1] 宋嘉[1] 刘鸿[1] 吴玉红[1] 王化泉[1] 邢莉民[1] 关晶[1] 王珺[1] 李丽娟[1] 

机构地区：[1]天津医科大学总医院血液肿瘤科,天津300052

出　　处：《中国实用内科杂志》2009年第12期1103-1105,共3页Chinese Journal of Practical Internal Medicine

基　　金："十一五"国家科技支撑计划(2008BAI61B02);天津市科技支撑计划;重大疾病防治专项基金(07ZCGYSF00600);天津市应用基础及前沿技术研究计划(09JCYBJC11200)

摘　　要：目的评价IA方案[去甲氧柔红霉素(IDA)+阿糖胞苷(Ara-C)]和DA方案[柔红霉素(DNR)+Ara-C]治疗高危骨髓增生异常综合征(MDS)、急性髓系白血病(AML)及MDS转AML患者的疗效和不良反应。方法应用IA方案治疗2005年2月至2008年10月天津医科大学总医院血液肿瘤科收治的AML18例、高危MDS或MDS转AML11例,DA方案治疗原发AML26例。结果(1)AML患者中,IA和DA方案总有效率(完全缓解+部分缓解)分别为83.3%和53.8%(P=0.042);初治时白细胞>30×109/L患者,IA和DA方案总有效率分别为81.8%和25%(P=0.009);老年患者(年龄≥65岁)中,IA和DA方案总有效率分别为66.7%和0(P=0.045),差异均有统计学意义;(2)IA方案治疗AML和高危MDS或MDS转AML总有效率分别为83.3%和72.7%,差异无统计学意义;年龄和初治时白细胞数量对IA方案疗效无影响;(3)IDA主要不良反应为骨髓抑制,白细胞低于4×109/L持续平均(24.1±7.7)d,出血、胃肠道症状、肝肾损伤及心脏毒性均较低。结论治疗AMLIA方案优于DA方案,在高危MDS和(或)MDS转AML治疗中同样具有很好的疗效。年龄和初治时白细胞数量均对IA疗效无影响,其毒副反应小。因此,IA方案可作为治疗高危MDS或MDS转AML和AML患者的一线方案。Objective To compare the therapeutic and side effects of idarubicin （IDA） with those of daunonibicin（DNR） in combination with cytosine arabinoside （ CA ） on high-risk myelodysplastic syndromes and acute mycloid leukemia （AML）. Methods 29 patients（ 18 patients with AML,II patients with high-risk MDS or AML/MDS）were treated with IDA（ 12mg/m^2 ）for 3d and CA（ 150mg/m^2 ）for 7d（ IA arm）and 26 patients with AML with DNR（45mg/m^2 ）for 3d and CA（ 150mg/m^2 ） for 7d（ DA arm） as induction and consolidation therapies. Results （ 1 ） For AML patients, the effective rates（ CR ＋ PR） were 83.3% in IA arm and 53.8% in DA arm（ P =0. 042）;For patients with higher white blood eell count（≥30 ×10^9/L） ,the effective rates were 81.3% in IA arm and 25% in DA arm（P =0. 009） ;For elder patients（≥ 65y） ,the effective rates were 66. 7% in IA arm and 0% in DA arm（ P = 0. 045 ） ;（ 2 ）Treatment with IA could also offer significant advantages to high-risk MDS or AML/MDS patients with higher effective rates（ 83.3% ）which was similar to that of AML patients by IA（72.7% ）. Age and Hyperleukocytosis（ ≥30 × 10^9/L） could not affect the effective rates in IA arm;（ 3 ）The main toxicity of IA was longer myelosuppression with lower WBC below 4 × 10^9/L which was averagely up to （ 24. 1 ± 7.7 ） d. Hemorrhage, nausea, vomit, hepatic and renal dysfunction and heart toxicity occurred unfrequently. Conclusion IA was superior to DA as induction and consolidation therapies for AML and also effective for high-risk MDS or MDS- develeped AML. Age and hyperleukocytosis eould not affect the effects of IA. IA can be the first therapy choice for the patients with AML and high-risk MDS.

关 键 词：IA方案 急性髓系白血病 高危骨髓增生异常综合征 

分 类 号：R5[医药卫生—内科学]