不同蒽环类药物为基础的诱导方案治疗成人初治急性髓系白血病的疗效观察

发布时间：2018-01-31 19:53

本文关键词： 急性髓细胞白血病完全缓解率去甲氧柔红霉素国产进口柔红霉素不良反应　出处：《河北医科大学》2016年硕士论文　论文类型：学位论文

【摘要】：背景:急性髓系白血病(acute myeloid leukemia,AML)是骨髓造血干/祖细胞起源的恶性疾病,是一个具有高度异质性的疾病群,多数病例发病急,病情重,预后差,如不及时治疗中位生存期仅3个月。目前,经典的AML诱导缓解方案是以蒽环类药物联合阿糖胞苷的“3+7”方案,同时包括成份输血、及时有效的抗生素使用等强有力支持治疗使AML预后得到较大改善。国内外研究显示,AML患者治疗完全缓解率可达65%-85%。作为新型蒽环类药物,去甲氧柔红霉素与柔红霉素一样,成为急性髓系白血病的常用诱导药物,但目前国内外对两种药物的疗效差异尚无明确定论。另一方面,因国人经济耐受力不同,近年来,国产去甲氧柔红霉素(艾诺宁)在临床上已被广泛使用,其治疗效果、毒副作用与进口去甲氧柔红霉素(善唯达)的疗效差异尚无明确定论。目的:观察并分析去甲氧柔红霉素(IDA)(国产、进口)与柔红霉素(DNR)分R%联合阿糖胞苷化疗治疗成人初治非M3型急性髓系白血病的疗效及毒副作用。方法:回顾性分析河北医科大学第二医院血液科就诊的282例初治AML患者的临床资料,初诊时间2012年7月1日~2015年11月30日。其中应用IA方案(去甲氧柔红霉素(8-10)mg/m2/d,d1-3;阿糖胞苷(100-200)mg/m2/d,d1-7)221例,善唯达123例,艾诺宁98例;应用DA方案(柔红霉素(45-60)mg/m2/d,d1-3;阿糖胞苷剂量同IA方案)61例。分析并比较三组病例治疗后的临床疗效及不良反应的发生情况。结果:1三种方案治疗成人初治非M3型AML的CR率由高到低分别为:善唯达组85.4%、艾诺宁组75.5%、柔红霉素组57.4%,三组比较有统计学差异(P0.001),三组不良反应无明显差异;2与柔红霉素相比,去甲氧柔红霉素疗效较好,且疗效与用药剂量成正比。与善唯达相比,艾诺宁治疗缓解率略低;3三种药物疗效显著,三组主要的化疗相关不良反应均为骨髓抑制、感染、恶心呕吐等。不良反应在可控范围,均可作为一线应用的抗白血病药物。结论:三种药物联合阿糖胞苷诱导治疗成人初治急性髓系白血病,均可起到显著疗效。去甲氧柔红霉素CR率高于柔红霉素,在用药剂量区间中,疗效与用药剂量成正比,毒副反应可控。国产去甲氧柔红霉素可达到与进口药物相近的治疗效果,可作为临床一线应用的抗白血病药物。
[Abstract]:Background: acute myeloid leukemia (myeloid) is a malignant disease of bone marrow hematopoietic stem / progenitor cells. Is a highly heterogeneous disease group, most of the cases are acute, severe, poor prognosis, such as failure to treat the median survival period of only 3 months. At present. The classic AML induced remission regimen is the "37" regimen with anthracyclines combined with cytarabine, which also includes component blood transfusions. Prompt and effective use of antibiotics and other powerful support therapy can improve the prognosis of AML. Domestic and foreign studies show that. As a new anthracycline, daunorubicin, like daunorubicin, has become a common inducer of acute myeloid leukemia. On the other hand, because of the different economic tolerance of Chinese people, in recent years, domestic noroxonorubicin (Einonine) has been widely used in clinic. There is no clear conclusion on the therapeutic effect, side effects and the difference between imported normoxydaunorubicin and imported daunorubicin. Objective: to observe and analyze the effect of normoxydaunorubicin (IDA). Import) and daunorubicin (DNR). The efficacy and side effects of R% combined with cytarabine chemotherapy in the treatment of non-M3 type acute myeloid leukemia in adults were studied. The clinical data of 282 newly diagnosed AML patients in hematology department of the second Hospital of Hebei Medical University were analyzed retrospectively. The first visit was from July 1st 2012 to November 30th 2015. IA regimen was used. Cytosine arabinoside 100 ~ 200 mg / m ~ (2) / d ~ (-1) D _ (1-7) in 221 cases, Shanwei in 123 cases, Einonine in 98 cases; DA regimen (daunorubicin 45-60 mg / m2 / dnd1-3; Cytarabine dose is the same as IA regimen). 61 cases were analyzed and compared the clinical efficacy and adverse reactions after treatment in three groups. Results the CR rate of non-M3 type AML in adults treated with three different regimens of 1: 1 was from high to low, respectively. Group 85.4%. Einonine group 75.5 and daunorubicin group 57.4, there was significant difference among the three groups (P 0.001), there was no significant difference in adverse reactions among the three groups. 2Compared with daunorubicin, normoxydaunorubicin had a better curative effect, and the curative effect was proportional to the dosage. 3 the three drugs had significant curative effect. The main adverse reactions were bone marrow suppression, infection, nausea and vomiting in the three groups. The adverse reactions were in the controllable range. Conclusion: three drugs combined with cytosine arabinoside in the treatment of adult primary acute myeloid leukemia. The CR rate of normoxydaunorubicin was higher than that of daunorubicin. Domestic normoxydaunorubicin can achieve the same therapeutic effect as imported drugs and can be used as a clinical first-line antileukemia drug.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R733.71

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