两种诱导治疗方案治疗儿童急性髓系白血病效果观察

摘要

Objective To compare the efficacy and safety of induction therapy in 3+7 protocol and 3+10 protocol in children with acute myeloid leukemia (AML). Methods Two protocols were carried out in our hospital during January 2010 to January 2015, namely 3+7 protocol(AML-06,A group) and 3+10 protocol (modified AML protocol, B group). A total of 56 cases aged from 1 year-old to 13 year-old were enrolled in A group with male to female ratio at 31:25. Five of them were classified as FAB M1, 25 as M2, 11 as M4, 10 as M5, 2 as M6 and 3 as M7. Another 44 cases aged from 1 year to 12 years were enrolled in B group with a male to female ratio at 26:18, and 17 cases were classified as FAB M2, 14 as M4, 9 as M5, 2 as M6, and 2 as M7. Efficacy and adverse events were compared between the two groups. Results The complete remission rate (CR) of B group was 70.4%, while CR in A group was 48.2%. Considering the CR, 3+10 protocol showed higher efficacy than 3+7 protocol (P< 0.05). The major adverse event was bone marrow suppression. Treatment-related mortality (TRD) in A group was 1.8%, which was lower than that in B group (2.3%). The overall survival rate in A group was 75.0%, which was lower than that in B group (86.4%, P< 0.05). Conclusions The induction therapy of 3+10 protocol and 3+7 protocol showed effectiveness for AML treatment. The 3+10 protocol showed a higher CR than 3+7 protocol with no TRD increase, indicating that the 3+10 protocol should be recommended for AML treatment in children.%目的 评价两种诱导缓解治疗方案(3+7方案和3+10方案)治疗儿童急性髓系白血病(AML)的疗效.方法回顾分析2010年1月至2015年1月接受化疗的AML患儿100例,按入院时间分别接受3+7方案(AML-06方案,A组)和3+10方案(改良AML方案,B组),比较两组的疗效及不良反应.结果 A组56例,男31例、女25例,中位年龄8.2岁(全距1.0~13.0岁),FAB分型,M 1型5例、M 2型25例、M 4型11例、M 5型10例、M 6型2例、M 7型3例;B组44例,男26例、女18例,中位年龄9.3岁(全距1.4~12.5),FAB分型:M 2型17例、M 4型14例、M 5型9例、M 6型2例、M 7型2例.A组首疗诱导完全缓解(CR)率为48.2 %低于B组首疗完全缓解率(70.4 %),两组间差异有统计学意义(P<0.05).B组的骨髓抑制期较A组长,诱导化疗后中性粒细胞数、血红蛋白、血小板恢复时间也均较A组长,差异均有统计学意义(P均<0.05).A组化疗相关死亡率1.8 %,B组为2.3 %,差异无统计学意义(P>0.05).A组3年总生存率为75.0 %,B组总生存率为86.4 %,差异有统计学意义(P<0.05).结论 两种治疗方案对AML均有效,3+10方案完全缓解率高,不良反应无明显增加.