IA和HAD方案诱导治疗成人初诊急性髓系白血病的疗效比较  

Comparison of the efficacy of IA and HAD induction regimens in the treatment of patients with newly diagnosed acute myeloid leukemia:a single-center study

作　　者：张丛笑 邱少伟 宫本法 弓晓媛 李艳 刘云涛 房秋云 张广吉 刘凯奇 周春林 魏述宁 林冬 刘兵城 王迎 秘营昌 魏辉 王建祥 Zhang Congxiao;Qiu Shaowei;Gong Benfa;Gong Xiaoyuan;Li Yan;Liu Yuntao;Fang Qiuyun;Zhang Guangji;Liu Kaiqi;Zhou Chunlin;Wei Shuning;Lin Dong;Liu Bingcheng;Wang Ying;Mi Yingchang;Wei Hui;Wang Jianxiang(State Key Laboratory of Experimental Hematology,National Clinical Research Center for Blood Diseases,Haihe Laboratory of Cell Ecosystem,Institute of Hematology&Blood Diseases Hospital,Chinese Academy of Medical Sciences&Peking Union Medical College,Tianjin 300020,China)

机构地区：[1]中国医学科学院北京协和医学院血液病医院(中国医学科学院血液学研究所),实验血液学国家重点实验室,国家血液系统疾病临床医学研究中心,细胞生态海河实验室,天津300020

出　　处：《中华血液学杂志》2022年第5期383-387,共5页Chinese Journal of Hematology

基　　金：国家重点研发计划(2021YFC2500300);中国医学科学院医学与健康科技创新工程项目(2020-I2M-C&T-B-084);天津市公共卫生重大科技专项项目(21ZXGWSY00030)。

摘　　要：目的比较IA和HAD方案诱导治疗成人初诊急性髓系白血病(AML)患者的疗效。方法分析2014年5月至2019年11月在中国医学科学院血液病医院接受IA或HAD方案诱导化疗的199例成人初诊AML患者的完全缓解(CR)率、1个疗程微小残留病(MRD)转阴率、总生存(OS)和无复发生存(RFS)情况。评估年龄、初诊WBC、NPM1突变、FLT3-ITD突变、2017ELN危险度分层、第1次完全缓解(CR1)期造血干细胞移植(HSCT)和巩固化疗时使用大剂量阿糖胞苷(HDAC)对于不同诱导化疗组预后的影响。结果 199例患者中, 男104例, 女95例, 中位年龄37(15~61)岁。90例患者接受IA诱导方案, 109例接受HAD诱导方案。1个疗程诱导化疗后IA和HAD方案组的CR率分别为71.1%和63.3%(P=0.245), 流式细胞术MRD转阴率分别为53.3%和48.6%(P=0.509);3例患者诱导化疗1个疗程后60 d内死亡, IA组1例, HAD组2例;两组2年OS率分别为61.5%和62.1%(P=0.835), 2年RFS率分别为51.6%和57.8%(P=0.291), 差异均无统计学意义。多因素分析显示ELN危险度分层是两种诱导方案组的独立预后因素;CR1期HSCT是IA组患者OS和RFS的独立预后因素, 对于HAD组患者, CR1期HSCT是RFS的独立预后因素, 但不是OS的独立预后因素;年龄、高白细胞、NPM1突变和FLT3-ITD突变均无独立预后意义。结论 IA与HAD方案疗效相同, 均是AML有效的治疗方案。Objective To compare the efficacy of two induction regimens,namely,idarubicin combined with cytarabine(IA)versus the combination of homoharringtonine,daunorubicin,and cytarabine(HAD),in adult patients with newly diagnosed de novo acute myeloid leukemia(AML).Methods From May 2014 to November 2019,199 patients diagnosed with AML receiving either the IA or HAD regimens were assessed for overall survival(OS),relapse-free survival(RFS),as well as the CR rate and the MRD negative rate after induction therapy.The differences in prognosis between the two induction therapy groups was assessed according to factors,including age,white blood cell(WBC)count,NPM1 mutation,FLT3-ITD mutation,2017 ELN risk stratification,CR1 transplantation,and the use of high-dose cytarabine during consolidation therapy,etc.Results Among the 199 patients,there were 104 males and 95 females,with a median age of 37(15-61)years.Ninety patients received the IA regimen,and 109 received the HAD regimen.Comparing the efficacy of the IA and HAD regimens,the CR rates after the first induction therapy were 71.1%and 63.3%,respectively(P=0.245),and the MRD negative rates after the first induction therapy were 53.3%and 48.6%,respectively(P=0.509).One patient in the IA group and two in the HAD group died within 60 days after induction.The two-year OS was 61.5%and 70.6%,respectively(P=0.835),and the two-year RFS was 51.6%and 57.8%,respectively(P=0.291).There were no statistically significant differences between the two groups.Multivariate analysis showed that the ELN risk stratification was an independent risk factor in both induction groups;CR1 HSCT was an independent prognostic factor for OS and RFS in the IA patients and for RFS in the HAD patients but not for OS in the HAD patients.Age,WBC level,NPM1 mutation,and FLT3-ITD mutation had no independent prognostic significance.Conclusion The IA and HAD regimens were both effective induction regimens for AML patients.

关 键 词：白血病 髓样 急性 高三尖杉酯碱 伊达比星 抗肿瘤联合化疗方案 治疗结果 

分 类 号：R733.71[医药卫生—肿瘤]