不同剂量柔红霉素诱导化疗65岁以下原发初治急性髓系白血病患者的疗效分析  

Efficacy of Different Doses of Daunorubicin Induced Chemotherapy in Patients with Newly Diagnosed Primary Acute Myeloid Leukemia Under 65 Years Old

作　　者：龚帅格 王甫珏 王烁婷 郑沁[2] 帅晓[1] 马洪兵[1] 张丽[1] 陈心传[1] 吴俣[1] 贾永前[1] GONG Shuai-Ge;WANG Fu-Jue;WANG Shuo-Ting;ZHENG Qin;SHUAI Xiao;MA Hong-Bing;ZHANG Li;CHEN Xin-Chuan;WU Yu;JIA Yong-Qian(Department of Hematology,West China Hospital of Sichuan University,Chengdu 610041,Sichuan Province,China;Department of Laboratory Medicine,West China Hospital of Sichuan University,Chengdu 610041,Sichuan Province,China)

机构地区：[1]四川大学华西医院血液科,四川成都610041 [2]四川大学华西医院实验医学科,四川成都610041

出　　处：《中国实验血液学杂志》2021年第4期1071-1079,共9页Journal of Experimental Hematology

基　　金：四川省科技厅项目(17ZDYF2026)。

摘　　要：目的:比较不同剂量柔红霉素联合标准剂量阿糖胞苷诱导化疗原发初治急性髓系白血病(AML)患者的疗效和安全性。方法:回顾性分析2017年1月-2019年6月86例于本院住院且采用DA方案化疗的65岁以下原发初治AML患者的临床资料及预后,根据第一个诱导疗程使用的柔红霉素剂量将患者分为2组:增强剂量[75mg/(m^(2)·d)]组(35例)和标准剂量[60 mg/(m^(2)·d)]组(51例)。分析不同剂量柔红霉素对AML患者完全缓解(CR)率和微小残留阴性的完全缓解(MRD-CR)率、无复发生存(RFS)时间、总生存(OS)时间以及不良反应的影响。结果:所有AML患者的中位随访时间为15个月。增强剂量组患者的CR率显著高于标准剂量组(88.5%vs64.7%,P=0.029),MRD-CR率亦高于标准剂量组(71.4%vs 41.2%,P=0.008)。增强剂量组预计2年RFS率明显高于标准剂量组(68.4%vs 38.5%,P=0.015),但预计2年OS率差异无统计学意义(77.1%vs 66.7%,P=0.059),3-4级不良反应无明显差异。增强剂量的柔红霉素可延长FLT3-ITD-AML患者的RFS(13个月vs未达到,P=0.022)和OS(23个月vs未达到,P=0.029)。结论:增强剂量柔红霉素可以增加原发初治AML患者的缓解率和缓解深度,延长患者的RFS而不增加不良反应。Objective: To compare the efficacy and safety of different doses of daunorubicin combined with a standard dose of cytarabine as induction chemotherapy in newly diagnosed primary acute myeloid leukemia( AML)patients. Methods: The clinical data and outcome were retrospectively analyzed in 86 newly diagnosed primary AML patients who were under 65 years old and treated with daunorubicin combined with cytarabine( DA regimen) at West China Hospital of Sichuan University from January 2017 to June 2019. Patients were divided into 2 groups based on the dose of daunorubicin they received,35 cases in the escalated-dose group [75 mg/( m^(2) ·d) ] and 51 cases in the standard-dose group [60 mg/( m^(2)·d) ]. And then the effects of different doses of daunorubicin on complete remission( CR) rate,minimal residual disease( MRD)-negative CR rate,relapse-free survival( RFS),overall survival( OS),and adverse events were analyzed. Results: Median follow-up time of all the patients was 15 months. The CR rate and MRD-CR rate of the escalated-dose group was 88. 5% and 71. 4%,respectively,which were higher than 64. 7% and41. 2% of the standard-dose group( P = 0. 029,P = 0. 008). The estimated 2-year RFS of the escalated-dose group was68. 4%,which was higher than 38. 5% of the standard-dose group( P = 0. 015),but estimated 2-year OS showed no statistically significant difference( 77. 1% vs 66. 7%,P = 0. 059),as well as grade 3-4 adverse events. The escalated dose of daunorubicin had prolonged RFS( 13 months vs not reached,P = 0. 022) and OS( 23 months vs not reached,P= 0. 029) in the FLT3-ITD-AML patients. Conclusion: The escalated dose of daunorubicin can induce higher complete remission rate,deeper remission and longer duration of remission without increasing adverse events in newly diagnosed primary AML patients.

关 键 词：急性髓系白血病 柔红霉素 完全缓解率 不良反应 

分 类 号：R733.71[医药卫生—肿瘤]