大剂量柔红霉素联合标准剂量阿糖胞苷对中青年初发急性髓系白血病患者的近、远期疗效  

Short-term and long-term efficacy of high-dose Daunorubicin combined with standard dose Ara-C in young and middle-aged patients with acute myeloid leukemia

作　　者：艾国[1] 李文倩[1] 冯建明[1] Guo Ai;Wen-qian Li;Jian-ming Feng(Department of Hematology, Qinghai People's Hospital, Xining, Qinghai 810000, China)

机构地区：[1]青海省人民医院血液科,青海西宁810000

出　　处：《中国现代医学杂志》2017年第18期56-61,共6页China Journal of Modern Medicine

摘　　要：目的分析大剂量柔红霉素(DNR)联合标准剂量阿糖胞苷(Ara-C)对中青年初发急性髓系白血病(AML)患者的近、远期效果。方法选取2011年1月-2015年5月该院血液内科收治的并接受的大剂量[60 mg/(m2·d)]DNR联合100 mg/(m2·d)Ara-C的DA方案行诱导化疗的133例中青年初治AML患者为研究对象,归为观察组。并随机选择同期该院接受标准剂量DA诱导方案[45 mg/(m2·d)DNR联合100 mg/(m2·d)Ara-C]的125例中青年初治AML患者为对照组。比较两组的完全缓解率(CR)、各不良反应的发生率、早期死亡率、血中性粒细胞绝对计数(ANC)减少的持续时间以及血小板(PLT)减少持续时间,并均进行随访,截止至2016年12月,比较两组的1、2及3年的总生存率(OS)和无瘤生存率(DFS),采用单因素与多因素Cox比例风险模型筛选出影响达到CR的观察组患者OS和DFS的影响因素。结果 (1)两组的化疗前基线资料比较,差异无统计学意义(P>0.05),具有可比性。(2)观察组、对照组患者行1个疗程诱导化疗后的CR率分别为67.7%和57.6%,两组比较差异无统计学意义(P>0.05)。观察组患者2个疗程诱导化疗后的总CR率为82.0%,高于对照组的70.4%,差异有统计学意义(P<0.05)。两组的各不良反应发生率、早期死亡率、ANC和PLT减少的持续时间比较,差异无统计学意义(P>0.05)。(3)经过诱导化疗达到CR后,两组分别有103例(95.%)和84例(67.2%)患者均行1~4个疗程的巩固化疗,之后分别有21例(15.8%)、17例患者(13.6%)行异基因造血干细胞移植,2例(1.5%)、1例(0.8%)行自体造血干细胞移植。截止至末次随访时,两组患者的中位随访时间分别为26.8和28.0个月,两组化疗后1、2及3年的OS和DFS比较,差异无统计学意义(P>0.05)。(4)多因素Cox回归分析结果表明,对观察组患者诱导化疗达到CR的109例患者而言,预后危险分层、接受≥2个疗程大剂量Ara-C巩固化疗是影响患者OS的影响因素(P<0.05);预后危险分层�Objective To analyse the short-term and long-term efficacy of high-dose Daunorubicin(DNR)combined with standard dose cytarabine(Ara-C)in young and middle-aged patients with acute myeloid leukemia(AML).Methods Totally133young and middle-aged patients with newly diagnosed AML received high-dose[60mg/(m2·d)]DNR combined with standard dose[100mg/(m2·d)]of Ara-C from January2011to May2015were enrolled for study in observation group.And125young and middle-aged patients with newly diagnosed AML received standard dose DA induction therapy[45mg/(m2·d)DNR combined with100mg/(m2·d)Ara-C]during the same period were randomly selected for study in control group.Complete remission(CR)rate,the incidence of adverse reactions,early mortality,duration of reduction of blood absolute neutrophil count(ANC)and PLT were compared between the two groups.All cases were followed up until December2016.1-,2-,3-year overall survival(OS)and disease-free survival(DFS)were compared between the two groups.Univariate and multivariate Cox proportional hazard model were used to screen out the independent related factors for OS and DFS of patients reached CR in the observation group.Results There were no statistically significant differences in baseline data before treatment between the two groups(P>0.05).The CR rates after1course of induction chemotherapy in the observation group and the control group were67.7%and57.6%,respecfively and there was no significant difference between them(P>0.05).The total CR rate after2courses in the observation group was82.0%which was significantly higher than70.4%in the control group(P<0.05).There were no significant differences in the incidences of all adverse reactions,early mortality,duration of ANC and PLT reduction between the two groups(P>0.05).Researching CR after induction chemotherapy,103cases(95%)and84cases(67.2%)in the two groups received1-4courses of consolidation chemotherapy,then21cases(15.8%)and17cases(13.6%)underwent allogeneic hematopoietic stem cell transplantation,2cases(1.5%)and1case(0.8%)underw

关 键 词：柔红霉素 急性髓系白血病 不同剂量 阿糖胞苷 预后 

分 类 号：R733.71[医药卫生—肿瘤]