76例老年急性髓系AML(非APL)诱导化疗疗效及预后分析  

Analysis of Efficacy and Prognosis of Induction Chemotherapy in 76 Elderly Patients with Acute Myeloid Leukemia(Non-APL)

作　　者：杨华[1] 牛建花[1,2] 朱成英[1] 张琪[1,3] 朱海燕[1] 姚子龙[1] 周敏航[1] 王全顺[1] 于力[1] 靖彧[1] 

机构地区：[1]解放军总医院血液科,北京100853 [2]山东省济南市第四人民医院血液肿瘤科,山东济南250031 [3]江苏省南京市高淳县人民医院,江苏南京211300

出　　处：《中国实验血液学杂志》2014年第4期957-964,共8页Journal of Experimental Hematology

摘　　要：本研究旨在探讨老年急性髓系白血病(acute myeloid leukemia,AML)(非APL)的临床特点、诊断、治疗方法及预后。回顾性分析2000年1月至2010年1月收治的76例年龄≥60岁AML(非APL)患者的临床资料。按治疗方法分为诱导化疗组和最佳支持治疗组。诱导化疗组51例,接受以阿糖胞苷为基础的诱导化疗方案,包括DA、MA、HA、IA及CAG方案;最佳支持治疗组25例,接受羟基脲及输血等最佳支持治疗。对诱导化疗组与最佳支持治疗组患者的临床特点、诊断、治疗方法及预后进行了比较分析。结果表明,诱导化疗组和最佳支持治疗组的中位生存时间分别为5(0.2-89)个月和3(0.1-17)个月。两组的中位生存时间比较差异具有统计学意义(P<0.01),诱导化疗明显延长了老年白血病患者的生存期。诱导化疗组中有5名患者存活超过60个月,有1人存活9年余。第1疗程化疗后,诱导化疗组的患者完全缓解率(complete remission,CR)为(10/51)19.6%,部分缓解率(partial remission,PR)为(10/51)19.6%,总有效率39.2%;诱导缓解期的死亡率为(7/51)13.7%。最佳支持治疗组无1例获缓解。MA方案第1疗程化疗后CR率44.4%,总有效率55.5%,疗效较DA、HA、IA及CAG方案好。中位化疗周期数为3(1-14)周期。随访发现,诱导化疗组与最佳支持组3个月生存率分别为65%和42%,6个月两组生存率分别为43%和21%,1年生存率两组分别为29%和13%,5年生存率两组分别为13%和0%。随访结果显示出诱导化疗组生存优于最佳支持治疗组。诱导化疗组中51例中第1周期化疗无效(no response,NR)31例占60.8%。这部分患者的生存期与最佳支持治疗相比较差异无统计学意义。结论:诱导化疗可显著改善老年AML患者的预后,延长患者的中位生存期。老年AML患者诱导治疗缓解率较年轻患者低,诱导缓解方案用MA疗效较DA、HA、IA及CAG方案略好,若第1周期化疗未达到CR或PR的患者可以考虑最佳支持治疗。老年AMThis study was purposed to investigate the clinical features, diagnosis, treatment and prognosis of elderly patients with acute myeloid leukemia （AML） （non-APL）. The clinical datas of 76 elderly （ I〉 60 old years ） AML （ non- APL） patients from January 2000 to January 2010 were analyzed retrospectively. Acording to treatment methods, the 76 patients were divided into 2 groups： induction chemotherapy group （51 cases） and best supportive treatment group （25 cases）. The patients in induction chemotherapy group received the cytarabine-based induction chemotherapy regimens, including DA, MA, HA, IA and CAG; the patients in best supportive treatment group received supportive treatment including hydroxyurea, blood transfusion and so on. The clinical features, diagnosis, treatment and prognosis between 2 groups were compared. The results showed that the median survival times of patients in induction chemotherapy and best supportive treatment groups were 5 （0.2 -89） and 3 （0.1 - 17） months respectively, there was significantly statistical difference in mediam survival time between 2 groups （ P 〈 0.01 ） suggesting that the induction chemotherapy obvionsly prolonged the survival time of elderly CML patients. The 5 patients in induction chemotherapy group survived more than 60 months, one of them survived more than nine years. After the first cycle of chemotherapy, the complete remission （CR） rate of patients was 19.6% （ 10/51 ）, partial remission（PR） rate was 19.6% （ 10/51 ）, the overall response rate （ORR） was 39.2%, the mortality of patients in induction remission stage was 13.7% （7/51） in reduction chemothera- py group; no 1 case in best supportive treatment group reached to CR. The CR rate of patients by using MA regimen was 44.4% and its ORR was 55.5%, which was higher than that by using DA, HA, IA and CAG regimens. The median chemotherapy cycles were 3 （1 - 14）. The follow-up found that the 3 months-survival rate of patients was 65% and 42%, the 6

关 键 词：急性髓系白血病 老年患者 诱导化疗 最佳支持治疗 

分 类 号：R733.71[医药卫生—肿瘤]