阿糖胞苷联合柔红霉素与伊达比星治疗成人急性髓系白血病疗效观察  

Effect of cytarabine combined with daunorubicin and idarubicin in the treatment of adult acute myeloid leukemia

作　　者：丁洁 程辉 高磊 倪雄 陈洁 杨建民 章卫平 王健民 陈莉 DING Jie;CHENG Hui;GAO Lei;NI Xiong;CHEN Jie;YANG Jianmin;ZHANG Weiping;WANG Jianmin;CHEN Li(Department of Hematology,the First Affiliated Hospital of PLA Naval Medical University,Shanghai 200433,China)

机构地区：[1]中国人民解放军海军军医大学第一附属医院血液科,上海200433

出　　处：《新乡医学院学报》2021年第2期146-151,共6页Journal of Xinxiang Medical University

基　　金：上海市科学技术委员会科技攻关项目(编号:18411968100)。

摘　　要：目的探讨阿糖胞苷联合柔红霉素与伊达比星治疗成人急性髓系白血病(AML)的临床效果。方法选择2007年1月至2019年11月中国人民解放军海军军医大学第一附属医院收治的200例初治AML成人患者为研究对象,根据治疗方法将患者分为柔红霉素联合阿糖胞苷(简称DA方案)组(DA组,n=121)和伊达比星联合阿糖胞苷(简称IA方案)组(IA组,n=79)。DA组患者给予柔红霉素45~60 mg·m^(-2)·d^(-1)静脉滴注,第1~3天;阿糖胞苷100~200 mg·m^(-2)·d^(-1)分2次静脉滴注3~5 h,第1~7天。IA组患者给予伊达比星10~12 mg·m^(-2)·d^(-1)静脉滴注,第1~3天;阿糖胞苷100~200 mg·m^(-2)·d^(-1)分2次静脉滴注3~5 h,第1~7天。1个诱导治疗疗程后获得部分缓解(PR)或原始细胞下降≥60%的患者再重复原方案1个疗程,如果第2个诱导治疗疗程结束后仍未获得完全缓解(CR),换用其他化学治疗方案;获得CR的患者继续应用原方案再巩固治疗1个疗程。对2组患者临床疗效、生存状况及治疗期间的不良反应进行比较。结果第1个诱导治疗疗程后,IA组患者CR率显著高于DA组(P<0.05);第2个诱导治疗疗程后,IA组患者总缓解率(ORR)显著高于DA组(P<0.05);总疗程结束后,2组患者临床疗效比较差异无统计学意义(P>0.05)。根据细胞遗传学危险度分层,2组低危、中危、高危患者临床疗效比较差异均无统计学意义(P>0.05)。根据综合预后分层,IA组预后良好患者的CR率、ORR显著高于DA组(P<0.05),但2组预后中等、预后不良患者的临床疗效比较差异无统计学意义(P>0.05)。2组≥60岁患者的CR率、PR率、未缓解(NR)率及ORR比较差异均无统计学意义(P>0.05);IA组<60岁患者的CR率显著高于DA组,PR率显著低于DA组(P<0.05);2组<60岁患者的NR率、ORR比较差异均无统计学意义(P>0.05)。IA组患者中枢神经浸润发生率低于DA组(P<0.05),2组患者骨髓抑制、肺部感染、上呼吸道感染、心脏毒性的发生率比较差异无�Objective To investigate the clinical effect of cytarabine combined with daunorubicin or idarubicin in the treatment of adult acute myeloid leukemia(AML).Methods A total of 200 adult patients with newly diagnosed AML admitted to the First Affiliated Hospital of PLA Naval Medical University from January 2007 to November 2019 were selected as the research subjects,and the patients were divided into daunorubicin combined with cytarabine group(DA group,n=121)and idarubicin combined with cytarabine group(IA group,n=79)according to the treatment methods.Patients in the DA group were given daunorubicin 45-60 mg·m^(-2)·d^(-1)intravenously in the 1_(st)-3_(rd)day,and cytarabine 100-200 mg·m^(-2)·d^(-1)intravenously twice within 3-5 hours in the 1_(st)-7 th days;Patients in the IA group were given idarubicin 10-12 mg·m^(-2)·d^(-1)intravenously in the 1_(st)-3_(rd)day,cytarabine 100-200 mg·m^(-2)·d^(-1)intravenously twice within 3-5 hours in the 1_(st)-7 th days.The patients with partial remission(PR)or more than 60%decrease of initial cells after one course of inductive treatment were repeated the original regimen for one course of treatment,if the patients did not achieved complete remission(CR)after the second course of inductive treatment,the other chemotherapy was used.The patients with CR were treated with the original regimen for another course.The clinical efficacy,survival status and adverse reactions during treatment of the patients between the two groups were compared.Results After the first course of induction treatment,the CR rate of patients in the IA group was significantly higher than that in the DA group(P<0.05).After the second course of induction treatment,the overall remission rate(ORR)of patients in the IA group was significantly higher than that in the DA group(P<0.05).After the total course of treatment,there was no significant difference in the clinical effect of patients between the two groups(P>0.05).According to the cytogenetic risk stratification,there was no significant difference in the

关 键 词：急性髓细胞性白血病 柔红霉素 伊达比星 阿糖胞苷 

分 类 号：R733.71[医药卫生—肿瘤]