小剂量高三尖杉酯碱＋阿糖胞苷方案诱导治疗不同危险度分层急性髓系白血病效果分析  

Efficacy of low-dose cytarabine and harringtonine regimen as induction in different risk stratifications of acute myeloid leukemia

作　　者：李丹慧[1] 李国辉[1] 梁英民[1] 

机构地区：[1]第四军医大学唐都医院血液科,西安710038

出　　处：《白血病．淋巴瘤》2016年第1期57-60,64,共5页Journal of Leukemia & Lymphoma

基　　金：国家自然科学基金（81100354）

摘　　要：目的探讨小剂量（LD）-高三尖杉酯碱＋阿糖胞苷（HA）方案诱导治疗急性髓系白血病（AML）（除外M3）的临床效果。方法对52例接受LD-HA方案诱导治疗的AML患者资料进行回顾性分析，并依据分子生物学和细胞遗传学危险度分级，观察临床疗效、不良反应，随访长期生存，以同期49例伊达比星＋阿糖胞苷（IA）方案治疗患者为对照。结果1个疗程后，LD-HA组总有效（OR）率为71．2％（37／52）[完全缓解（CR）率50．0％（26／52），部分缓解（PR）率21．2％（11／52）]，IA组OR率为53．1％（26／49）[CR率44．9％（22／49），PR率8．2％（4／49）]，两组OR率差异无统计学意义（P=0．068）。按危险度分层，LD-HA组高危组的OR率高于IA组[100％（11／11）比66．7％（12／18）]，差异有统计学意义（P〈0．05）；LD—HA组和IA组的低危组和中危组OR率差异无统计学意义（P〉0．05）。LD—HA组心脏毒性及骨髓抑制均较IA组轻，不适合标准方案的AML患者亦对其耐受良好。结论LD-HA方案诱导治疗AML时，高危组OR率高，化疗相关不良反应发生率低，安全性较高。与标准方案相比，LD-HA对于高危AML患者可能更有效。Objective To explore the clinical efficacy of low-dose cytarabine and harringtonine （LD-HA） regimen in the induction therapy of acute myeloid leukemia （AML） except M3. Methods 52 AML patients who received LD-HA were analyzed retrospectively. The patients were graded according to molecular biological and cytogenetic risk degree. The clinical efficacy, toxicity of LD-HA and long-term survival followed-up were compared with those of idarubicin and cytarabine （IA） regimen in 49 patients. Results After one cycle, the overall remission （OR） rates of LD-HA group and IA group were 71.2 % （37/52） [CR rate 50.0 % （26/52）, PR rate 21.2 % （11/52）] and 53.1% （26/49） [CR rate 44.9 % （22/49）, PR rate 8.2 % （4/49）], respectively, with no statistical significance of OR between the two groups （P = 0.068）. OR rates were not statistically significant in either low-risk group or intermediate-risk group between LD-HA group and IA group （P 〉 0.05）, but OR of high-risk group in LD-HA was much higher than that in IA group [100 % （11/11） vs 66.7 % （12/18）, P 〈0.05]. Cardiac toxicity and bone marrow suppression in LD-HA group were much milder than those in IA group. The patients unfit for standard chemotherapy could tolerate to LD-HA regimen. Conclusions LD-HA regimen as induction for high risk AML patients can improve the OR rate, and reduce the side effects, which is beneficial for high-risk AML patients.

关 键 词：小剂量HA方案 白血病 髓样 急性 危险度分层 分子生物学 细胞遗传学 

分 类 号：R733.71[医药卫生—肿瘤]