老年低增生性急性髓细胞白血病CAG诱导及缓解后强化治疗生存分析

摘要

Objective To Explore the therapy of elderly patients with hypoproliferative acute myeloid leukemia.Methods Twenty-six elderly patients with hypoproliferative acute myeloid leukemia had received induction of CAG regimen and 15 cases were treated intensive chemotherapy after complete remission,then if achieving complete remission had received subsequent intensive chemotherapy: stand or reduce AA, DA or HA regimen.Results In 26 cases patients who received CAG regimen,the complete remission rate, partial remis sionrat and the totle total effective rate were 53.85％ (14/26), 19.23％ (5/26) and 73.08％ (19/26), respectively.Accordance with response to CAG regimen and the therapy after complete remission, 26 patients were divided into 3 groups:intensive chemotherapy after complete remission(CR1), non-intensive chemotherapy after complete remission(CR2) and non-remission(NR, including partial remission patients).The median overall survival of CR1 ,CR2 and NR were 13.5 months, 8.2 months, and 4.5 months, respectively.There was higher median overall survival of CR1 group than CR2 and NR groups (P =0.041,0.001, respectively).There was higher OS of CR2 group than NR group (P =0.064).No serious bleeding events were found in chemotherapy.Conclusion CAG regimen was an effective and little adverse effect regimen for the treatment of elderly H-AML,and with well tolerance in patients.Advisable intensive chemotherapy can prolong the patient's survival time after complete remission.%目的 观察老年低增生性急性髓细胞白血病(AML)经CAG诱导及缓解后强化治疗的效果.方法 26例老年低增生性AML患者接受CAG方案诱导治疗及15例完全缓解后行强化治疗.初治方案为CAG预激方案,获完全缓解后继续应用AA、DA、HA方案进行化疗.结果 26例患者CAG方案化疗后完全缓解(CR)率53.85％(14/26),部分缓解率19.23％ (5/26),总有效率73.08％(19/26).根据CAG方案疗效及完全缓解后有无进行强化治疗,将患者分成3组:完全缓解后强化治疗组(CR1组)、完全缓解后未强化治疗组(CR2组)、未缓解组(NR组,部分缓解患者归入该组),进行生存分析,其中位生存时间分别是13.5个月、8.2个月、4.5个月.各组进行比较,CR1组较CR2组、NR组有较长的生存时间,差异有统计学意义(P值分别为0.041、0.001).CR2组较NR组有较长的生存时间,但差异无统计学意义(P=0.064).化疗中未发现严重出血事件.结论 CAG预激方案诱导对老年低增生性AML有效率较高,而且化疗相关毒副作用小,患者耐受性好.完全缓解后继续适当强化治疗有益于延长患者生存时间.