HDA作为诱导方案治疗成人急性非淋巴细胞白血病的疗效分析  

Efficacy of HDA regimen as induction chemotherapy in newly diagnosed acute myeloid leukemia

作　　者：刘忠文[1] 孔黛[1] 郭建民[1] 张茵[1] 张琳[1] 杨靖[1] 

机构地区：[1]河南省人民医院血液科,郑州450003

出　　处：《医药论坛杂志》2014年第12期53-57,共5页Journal of Medical Forum

摘　　要：目的探讨高三尖杉酯碱＋柔红霉素＋阿糖胞苷（HDA）方案治疗急性髓系白血病（AML）的疗效和不良反应。方法运用HDA方案（高三尖杉酯碱2.5 mg/m2d1～7,柔红霉素45 mg/m2d1～3,阿糖胞苷100 mg/m2d1～7）对2009年1月至2012年12月河南省人民医院血液科收治的51例初治成人AML进行诱导化疗,并根据危险分层进行缓解后治疗,分析完全缓解率、3年生存率及3年无复发生存率。结果在51例初治的成人AML,经过1~2疗程的HDA方案诱导化疗,完全缓解率达到78.4%,预后良好组、中危组及高危组的完全缓解率分别为90%、86.2%和50%。51例患者的3年总生存率为45.2%,按危险分层,预后良好组、中危组及高危组的3年生存率分别为66.7%、51%和20.8%。对于40例取得完全缓解的患者,3年无复发生存率57.7%,预后良好组、中危组及高危组的3年无复发生存率分别为75%、59.5%和33.3%。在中、高危组取得完全缓解后进行干细胞移植及未进行移植的患者,3年无复发生存率分别为75%、34.6%。结论对于年龄小于60岁的AML患者,HDA方案不失为一个行之有效且安全可行的诱导化疗方案。良好的细胞遗传学及异基因干细胞移植对于提高AML患者的生存率具有重要意义。Objective To assesse the efficacy and toxicity of the HDA regimen （ homoharringtonine 2. 5 mg/m2 intrave- nously on days 1 -7 ,daunorubicin 45 mg/m2 intravenously on days 1 ~ 3 ,and cytosine arabinoside 100 mg/m2/day con- tinuous infusion on days 1 - 7 ）as induction chemotherapy in patients aged 〈 60 years with de novo acute myeloid leuke- mia（AML）. Methods Totally 51 patients aged 〈 60 years with de novo AML were treated with HDA regimen. The o- verall complete remission ,3 -year overall surviva rate （OS）and 3 -year relapse -free survival rate （RFS）were ana- lysed. Results After one or two courses of induction therapy, the overall complete remission（CR） rate was 78. 4%. 90% patients with better-risk cytogenetics,86. 2% patients with intermediate-risk cytogenetics and 50% patients with poor - risk cytogenetics achieved CR. Estimated 3 - year OS rate of all patients was 45.2%. In patients with better - risk,in- termediate - risk, and poor - risk cytogenetics, the estimated 3 - year OS rate was 66. 7% , 51%, 20. 8% respectively. The estimated RFS at 3 years of the 40 CR patients was 57.7%. That of patients with better- risk, intermediate -risk, and poor - risk cytogenetics was 75% ,59. 5% and 33.3%. In intermediate - and poor - risk groups estimated RFS at 3 years was 75% in patients who underwent allo - SCT and 34. 6% in those only received regular postremission chemother- apy. Conclusion HDA is efficacious in treating patients with newly diagnosed AML. Good cytogenetic profile and allo - SCT were of great benefit to prolonged survival.

关 键 词：急性非淋巴细胞白血病 高三尖杉酯碱 诱导化疗 

分 类 号：R733.7[医药卫生—肿瘤]