不同剂量去甲氧柔红霉素联合阿糖胞苷诱导治疗年轻初发急性髓系白血病的疗效和安全性分析  

Efficacy and safety analysis of different dose idarubicin plus cytarabine regimen as induction chemotherapy for young patients with de-novo acute myeloid leukemia

作　　者：张仪[1] 姚徐明 朱双丽 索珊珊[1] 毛莉萍[1] 韦菊英[1] 俞文娟[1] 麦文渊[1] 佟红艳[1] 孟海涛[1] 钱文斌[1] 金洁[1] 

机构地区：[1]浙江大学附属第一医院血液科,杭州310003 [2]嘉兴市第一医院肿瘤内科

出　　处：《中华血液学杂志》2016年第8期682-687,共6页Chinese Journal of Hematology

基　　金：浙江省重点创新团队（2011R50015）;国家自然科学基金（81370643-H0812）

摘　　要：目的探讨不同剂量去甲氧柔红霉素（IDA）联合阿糖胞苷诱导方案（IA）治疗年轻初发急性髓系白血病（AML）（除外急性早幼粒细胞白血病）的临床疗效、安全性和长期预后。方法回顾性分析2009年1月至2014年7月收治的采用IA方案治疗的149例〈55岁初发AML患者临床资料，根据IDA剂量分为高标准剂量组（10-12mg·m^-2·d^-1）、低标准剂量组（8-9mg·m^-2·d^-1）和低剂量组（〈8mg·m^-2·d^-1），比较各组患者的化疗反应、血液学及非血液学不良事件，并分析预后。结果高标准剂量组34例，低标准剂量组53例，低剂量组62例。三组第1个疗程完全缓解（CR）率分别为79．4％、75．5％和46．8％，第1个疗程有效率分别为97．1％、94．3％和64．5％，总CR率分别为85．3％、81．1％和54．8％，高标准剂量组、低标准剂量组均显著高于低剂量组（P值均〈0．05），前两者间差异无统计学意义（P值均〉0.05）。多因素分析证实标准IDA剂量的确在诱导缓解疗效上优于低剂量（P〈0．05）。在不良反应方面，化疗期间WBC最低值三组问差异有统计学意义（P=0．002），其余差异均无统计学意义。低标准剂量组在总生存（OS）上显著优于低剂量组（P=0．030），高标准剂量组与低剂量组相比，OS也有改善的趋势（P=0．054）。三组间在无事件生存、无复发生存差异均无统计学意义（P值均〉0．05）。结论对于年轻（〈55岁）初发AML患者，标准剂量IA方案可显著提高CR率，且患者的耐受性良好。标准剂量IA方案在一定程度上能改善年轻（〈55岁）AML患者OS。Objective To compare the efficacy, safety and long-term prognosis between different dose idarubicin （IDA） combined with cytarabine （IA） as induction chemotherapy in newly diagnosed young patients of acute myeloid leukemia （AML）. Methods A total of 149 newly diagnosed young AML patients （APL excluded） between January 2009 to July 2014 was enrolled. According to the dose of IDA, the patients were divided into three groups, high standard-dose IA group （10-12 mg·m^-2·d^-1）, low standard-dose IA group （8-9 mg·m^-2·d^-1） and low-dose IA group （〈8 mg·m^-2·d^-1）. The efficacy, adverse effects and long-term prognosis among the three groups were compared. Results Of them, 34 patients were in high standard-dose IA group, 53 in low standard-dose IA group and 62 in low-dose IA group. After one cycle of induction chemotherapy, the complete remission （CR） rate was 79.4%, 75.5% and 46.8%, the overall response （OR） rate was 97.1%, 94.3% and 64.5%, and the overall CR rate was 85.3%, 81.1% and 54.8%, respectively. Compared with low-dose IA group, high standard-dose IA group and low standard- dose IA group had significantly better result （P〈0.05）, but there was no significant difference between the latter two groups （P 〉 0.05）. Multivariate analysis also showed that standard-dose IA was favorable factor for induction chemotherapy （P〈0.05）. The adverse effects were similar in the three group, other than the lowest count of WBC （P=-0.002）. Low standard-dose IA can improve the OS compared to the low-dose IA （P=0.003）, but EFS, RFS was similar in the three groups. Conclusions （〈55） AML patients, the standard-dose IA has better CR rate.The adverse effects were similar in the three groups. High-dose IA may improve the OS compared to the low-dose IA.

关 键 词：白血病 髓样 急性 去甲氧柔红霉素 疗效比较研究 

分 类 号：R733.71[医药卫生—肿瘤]