HAA方案诱导治疗成人初发急性髓系白血病236例疗效观察  

Efficacy and safety of the HAA regimen as induction chemotherapy in 236 de novo acute myeloidleukemia

作　　者：叶佩佩 牧启田[1] 陈菲菲[1] 麦文渊[1] 孟海涛[1] 钱文斌[1] 佟红艳[1] 黄健[1] 童茵[1] 陈志妹[1] 楼基余[1] 王云贵[1] 倪万茂[1] 金洁[1] 

机构地区：[1]浙江大学医学院附属第一医院血液科,杭州310003 [2]浙江省宁波市鄞州人民医院血液科,315040

出　　处：《中华血液学杂志》2013年第10期825-829,共5页Chinese Journal of Hematology

基　　金：卫生公益性行业科研专项（201202017）;国家自然科学基金（81070418H0812）;浙江省重点创新团队（201IR50015）

摘　　要：目的评估HAA（高三尖杉酯碱＋阿糖胞苷＋阿柔比星）方案诱导治疗成人初发急性髓系白血病（AML）的疗效及不良反应。方法回顾性分析236例成人初发AML患者采用HAA方案作为诱导化疗方案的疗效和不良反应，统计完全缓解（CR）率，用Kaplan-Meier法分析224例仅接受化疗的患者5年总生存（OS）和无复发生存（RFS）率，采用Log-rank检验进行亚组间比较。结果236例患者总CR率为78．0％，其中65．7％的患者1个疗程后获得CR，早期病死率4．7％。中位随访41（1～161）个月，5年OS率和RFS率分别为44．9％和45．5％。按染色体核型分组，低危、中危和高危患者的CR率分别为92．9％、78．6％和41．7％；低危组和中危组5年OS率分别为61．1％和45．1％，5年RFS率分别为49．0％和45．4％，而高危组中位生存时间仅为5个月。HAA方案相关的不良反应主要为骨髓抑制及感染，患者可以耐受。结论HAA方案作为首选方案治疗成人初发AML患者具有较高的缓解率及长期生存率，不良反应可以耐受。Objective To evaluate the efficacy and safety of the HAA regimen （homoharringtonine, cytarabine and aclarubicin） as induction chemotherapy in de novo acute myeloid leukemia（AML）. Methods The efficacy and safety of 236 de novo AML patients who received the HAA regimen as induction chemotherapy were retrospectively analyzed. The complete remission （CR） rate was assayed. Kaplan-Meier method was used to estimate overall survival （OS） and relapse free survival （RFS）, and the differences were compared by Log-rank test. Results The overall CR rate was 78.0%, and 65.7% of the patients attained CR in the first induction cycle. The early death rate was 4.7%. The median followup time was 41 （1-161 ）months. The estimated 5-year OS and 5-year RFS rates were 44.9% and 45.5%, respectively. The CR rates of patients with favorable, intermediate and unfavorable cytogenetics were 92.9%, 78.6% and 41.7%, respectively. The 5-year OS of favorable and intermediate group were 61.1% and 45.1%, respectively. The 5-year RFS of favorable and intermediate group were 49.0% and 45.4%, respectively. The median survival time of unfavorable group was only 5 months. The side effects associated with the HAA regimen were tolerable, in which the most common toxicities were myelosuppression and infection. Conclusion The HAA regimen is associated with a higher rate of CR and longer survival time and its toxicity could be tolerated.

关 键 词：白血病 髓样 急性 高三尖杉酯碱 抗肿瘤联合化疗方案 预后 

分 类 号：R733.7[医药卫生—肿瘤]