DHA和DAE方案用于儿童急性髓系白血病诱导治疗的临床观察  

Clinical observation of DHA and DAE regimens for acute myeloid leukemia in children

作　　者：张丽芬 李莲 张晓春[2] ZHANG Lifen;LI Lian;ZHANG Xiaochun(Department of Pediatrics, Wuzhong People's Hospital Affiliated to Ningxia Medical University, Wuzhong 751100, China)

机构地区：[1]宁夏医科大学附属吴忠市人民医院儿科,宁夏吴忠751100 [2]宁夏医科大学总医院儿科,750004

出　　处：《临床肿瘤学杂志》2020年第7期625-630,共6页Chinese Clinical Oncology

基　　金：宁夏自然科学基金资助项目(NZ5167)。

摘　　要：目的探讨柔红霉素+高三尖杉酯碱+阿糖胞苷(DHA)方案与柔红霉素+阿糖胞苷+依托泊苷(DAE)方案治疗儿童急性髓系白血病(AML)的疗效及不良反应。方法回顾性分析2010年3月至2015年10月收治的76例AML患儿(非M3型)的临床资料。根据所接受的化疗方案将患儿分为DHA组(n=38)和DAE组(n=38)。DHA组方案如下:柔红霉素40~45 mg/m^2静滴,d1~d3;高三尖杉酯碱2~2.5 mg/m^2静滴,d1~d7;阿糖胞苷100~150 mg/m^2静滴,d1~d7。DAE组方案如下:柔红霉素40~45 mg/m^2静滴,d1~d3;阿糖胞苷100~150 mg/m^2静滴,d1~d7;依托泊苷100 mg/m^2口服,d1~d5。两方案均以28天为1个周期。比较两组患儿近期疗效、总生存时间(OS)、无事件生存时间(EFS)和不良反应。采用Cox回归模型分析影响患儿EFS的独立因素。结果DHA组获CR124例,CR 31例,PR 4例,OR为92.1%;DAE组获CR115例,CR 23例,PR 5例,OR为73.7%。两组OR的差异有统计学意义(P=0.033)。DHA组中位OS为32个月(95%CI:13~36个月),长于DAE组的20个月(95%CI:7~36个月),差异有统计学意义(P=0.043);DHA组中位EFS为26个月(95%CI:8~36个月),长于DAE组的17个月(95%CI:5~36个月),差异有统计学意义(P=0.011)。DHA组发生1例早期死亡,DAE组发生2例。两组不良反应主要表现为胃肠道反应、血红蛋白减少、感染和出血等。DHA组患儿在治疗期间3级及3级以上不良反应的发生率为21.0%,DAE组为28.9%,差异无统计学意义(P=0.427)。Cox多因素分析显示,化疗方案和遗传学危险度分级是影响EFS的独立因素(P<0.05),接受DHA方案化疗和遗传学危险度分级低危的患儿EFS较长。结论DHA方案治疗AML疗效较好,能够明显提高近期疗效,延长OS和EFS。Objective To investigate the efficacy and safety of daunorubicin+homoharringtonine+cytarabine(DHA)regimen and daunorubicin+cytarabine+etoposide(DAE)regimen for children with acute myeloid leukemia(AML).Methods From March 2010 to October 2015,76 children with AML(non-M3 type)were collected and analyzed retrospectively.According to induction chemotherapy regimen,the children with AML were divided into DHA group and DAE group with 38 cases in each group.DHA regimen was given as follows:daunorubicin 40-45 mg/m^2 iv d1-d3,homoharringtonine 2-2.5mg/m^2 iv d1-d7,cytarabine 100-150 mg/m^2 iv d1-d7.DAE regimen was as follows:daunorubicin 40-45 mg/m^2iv d1-d3,cytarabine 100-150 mg/m^2 iv d1-d7,etoposide 100 mg/m^2po d1-d5.Twenty-eight days was a cycle for the both two regimens.Short-term efficacy,overall survival(OS),event-free survival(EFS)and adverse reactions were compared between the two groups.The multivariate Cox regression model was used to analyze independent factors affecting EFS.Results CR1 in DHA and DAE groups were observed in 24 and 15 cases,CR in 31 and 23 cases,PR in 4 and 5 cases,and OR were 92.1%and 73.7%(P=0.033).The median OS of DHA group was 32(95%CI:13-36)months,and that in DAE group was 20(95%CI:7-36)months with statistical significance(P=0.043).The median EFS of DHA group was 26(95%CI:8-36)months,and that in DAE group was 17(95%CI:5-36)months with statistical significance(P=0.011).One early death occurred in DHA group,while 2 cases in DAE group.The main adverse reactions were digestive tract reaction,hemoglobin reduction,hemorrhage,infection,and et al.The incidence of grade 3 and above adverse reaction in DHA and DAE groups were 21.0%and 28.9%without statistical significance(P=0.427).Cox regression analysis showed chemotherapy and genetic grade were independent factors affecting EFS(P<0.05).Patients receiving DHA regimen and with low risk of genetic grade had better EFS.Conclusion DHA regimen can significantly enhance the induction remission rate,prolong OS and EFS in children with AML.

关 键 词：急性髓系白血病(AML) 儿童 化学治疗 DHA方案 

分 类 号：R733.71[医药卫生—肿瘤]