依托泊苷联合G-CSF、低剂量阿糖胞苷、阿克拉霉素治疗初诊老年急性髓系白血病的临床研究  

Efficacy and safety of etoposide in combination with G-CSF,low-dose cytarabine and aclarubicin in newly diagnosed elderly patients with acute myeloid leukemia

作　　者：朱丽丹[1] 张曦[1] 冯一梅[1] 颜红菊[1] 张彦琦[2] 曾韫璟[1] 饶军[1] 刘嘉[1] 张诚[1] 高力[1] 孔佩艳[1] 刘耀[1] 高蕾[1] 

机构地区：[1]第三军医大学新桥医院全军血液病中心,重庆400037 [2]第三军医大学新桥医院医学统计学教研室,重庆400037

出　　处：《中国输血杂志》2016年第10期1099-1101,共3页Chinese Journal of Blood Transfusion

摘　　要：目的老年急性髓系白血病患者的治疗目前依然面临巨大挑战,虽然有50%的患者通过化疗可能达到完全缓解,但往往难以耐受化疗相关毒性。2013年,中国西南地区的一项多中心随机临床对照研究证实依托泊苷联合低剂量CAG方案可使71.1%的复发难治AML患者达到完全缓解,且化疗相关毒性较低,此方案是否适用于老年AML的诱导治疗尚无研究报道。方法回顾性分析本中心87例E-CAG方案治疗老年初诊AML患者的效果和安全性。主要研究终点为完全缓解率,次要研究终点包括:2年总生存(OS)、无病生存(DFS)和化疗相关不良反应。结果E-CAG方案诱导化疗组完全缓解率(62.1%),2年OS 10.3%,2年DFS 9.2%,中位生存时间13个月。E-CAG方案化疗相关不良反应仍以血液学毒性为主,大多数患者能够耐受。E-CAG方案诱导化疗达到完全缓解的患者,采用非清髓异基因造血干细胞移植后2年OS和DFS均为40%;中剂量阿糖胞苷化疗强化组2年OS 25%,DFS 16.7%;常规化疗维持组2年OS和DFS为6.25%。结论 E-CAG诱导方案治疗老年初诊AML具有满意的疗效和较低的化疗相关不良反应,桥接非清髓造血干细胞移植有望显著提高老年急性髓系白血病的治疗效果。Objective Chemotherapy for elderly patients with acute myeloid leukemia （AML） is still a great challenge. Although 50% AML patients could achieve complete remission （CR） after intensive 3 ＋ 7 regimen, treatment-related toxicities （TRT） appeared particularly prominent in elderly patients. In 2013, a multi-center randomized controlled trial in southwestern China confirmed that 71.1% refractory or relapsed AML achieved CR after received etoposide combine with low-dose CAG （E-CAG） regimen, and TRT was low, with no mortality. Methods This retrospective study was designed to assess the efficacy an,] safety of E-CAG induction treatment for elderly patients with newly diagnosed AML. The effect of E-CAG on the rate of CR was the main study end-point. The rate of 2-year overall survival （OS） / disease-free survival （DFS） and the toxicity of the E-CAG regimen were also evaluated. Results After induction chemotherapy with E-CAG regimen, the rate of CR was 62. 1%. The two-year OS and DFS probability were 10. 3% and 9.2%, perspectively. The median survival time was 13months. Hematologic toxicity was the major adverse reaction. Especially, the two-year OS probability was different in different Intensive treatment regimen, non-myeloablative HSCT was 40%, intermediate-dose cytarabine was 25%, and maintenance chemotherapy was 6. 25%. Conclusion The E-CAG regimen seems promising and offers lower toxicity for the treatment of elderly patients with AML, and expected to become a bridge for non-myeloablative stem cell transplantation.

关 键 词：急性髓系白血病 老年 足叶乙甙 低剂量 化疗 

分 类 号：R733.71[医药卫生—肿瘤] R457.1[医药卫生—临床医学]