老年急性髓系白血病诱导化疗的临床分析

发布时间：2018-04-13 10:24

本文选题：老年 + 急性髓系白血病　；参考：《安徽医科大学》2016年硕士论文

【摘要】：目的:探讨联合诱导化疗方案治疗老年急性髓系白血病(acute myeloid leukemi a,AML)患者的疗效和预后。方法:回顾性分析2000年1月至2015年4月年龄≥60岁40例老年AML患者的临床资料,包括M1 2例,M2 21例,M4 6例,M5 3例,M6 3例,未分型3例,继发性2例。26例患者接受诱导化疗,其中柔红霉素+阿糖胞苷(Daunorubici+Cy tarabine,DA)方案14例,米托蒽醌+阿糖胞苷(Mitoxantrone+Cytarabine,MA)方案4例,阿克拉霉素+阿糖胞苷+粒细胞集落刺激因子(aclacinomycin+Cytarab ine+granulocyte colony-stimulating factor,CAG)方案8例;14例患者接受姑息治疗,给予皮下注射小剂量阿糖胞苷10-20mg/m2.d、口服羟基脲、抗感染、成分输血等支持治疗。经过1-2个疗程的诱导化疗达完全缓解(complete remissio n,CR)或者部分缓解(partial remission,PR)的患者,予原方案或者其他方案巩固化疗。比较诱导化疗组和姑息组疗效及预后差异。结果:化疗组12例获得CR,CR率46.1%,4例获PR,PR率15.4%,总有效(ove rall response,OR)率为61.5%,1例早期死亡(3.8%)。其中DA方案14例,6例CR,CR率42.8%;MA方案4例,2例CR,CR率50.0%;CAG方案8例,4例CR,CR率50%。三种方案的CR差别无统计学意义(P=1.0)。复发率54.5%,再次CR率16.7%。诱导缓解化疗经1个疗程达CR率58.3%,经2个疗程达CR率41.7%。化疗组年龄大于70岁CR率27.3%,早期死亡率9.1%,70岁以下患者分别为60%和0%。WBC≥100×109/L患者,无1例CR,中位生存时间仅1月。ECOG评分为2与≥2两组的CR率分别为45%和12%。1例WT1阳性CR,1例FLT3-ITD阳性CR。预后良好核型2例,1例CR,1例未缓解(none remission,NR);预后中等核型3例,1例CR,2例NR;预后不良核型5例,1例CR,2例PR,2例NR。姑息组无1例CR,早期死亡2例(14.3%)。两组患者发生早期死亡主要为严重肺部感染、脑出血、呼吸及循环衰竭等原因。化疗组中位生存时间5.8个月,姑息组中位生存时间2.5月,1年生存率分别为19.2%及7.0%,2年生存率分别为15.4%及0.0%,化疗组中位生存时间高于姑息治疗组(P=0.024)。诱导化疗组不良反应主要包括胃肠道反应、骨髓抑制、出血、肺部感染、肝功能异常及心功能异常,经成分输血及抗感染等对症支持治疗多数可耐受,其中有4例患者死于严重并发症。诱导化疗组胃肠道反应、骨髓抑制、出血不良反应明显高于姑息组,并且差异有统计学意义(P0.05)。结论:联合诱导化疗治疗老年AML较姑息治疗可延长患者中位生存期。老年患者耐受力差,治疗不良反应多。
[Abstract]:Objective: to investigate the efficacy and prognosis of combined induction chemotherapy in the treatment of elderly patients with acute myeloid leukemi (AMLA).Methods: the clinical data of 40 elderly AML patients aged more than 60 years from January 2000 to April 2015 were retrospectively analyzed, including 21 cases of M 1, 21 cases of M 2, 56 cases of M 3, 3 cases of unclassified, 2 cases of secondary and 26 cases of induced chemotherapy.14 patients received palliative treatment with Daunorubici Cy tarabineDAA, 4 with mitoxantrone cytarabine MAA, 8 with aclacinomycin Cytarab ine granulocyte colony-stimulating CAGG.Subcutaneous injection of cytarabine 10-20 mg / m2 d, oral hydroxyurea, anti-infection, component transfusion and other support treatment.Patients with complete remission complete remissio or partial remission after 1-2 courses of induction chemotherapy were treated with either the original or other regimens for consolidation chemotherapy.The curative effect and prognosis of induced chemotherapy group and palliative group were compared.Results: in the chemotherapy group, the CR rate was 46.1% and the PR rate was 15.4% in 4 cases. The total effective rall response rate was 61.5% and the early death rate was 3.8%.The CR rate of 14 cases with DA regimen was 42.8% and that of 4 cases with MA regimen was 42.8%. The CR rate of 2 cases was 50.0%. The CR rate of 4 cases with CAG regimen was 50%, while that of 8 cases with CAG regimen was 50%.There was no significant difference in CR between the three schemes.The recurrence rate was 54.5 and the CR rate was 16.7.The CR rate of induced remission chemotherapy was 58.3% in one course and 41.7% in 2 courses.One case had no remission of none remissionation NRR, 3 cases had moderate karyotype, 1 case had CR2 NRR, 5 cases had poor prognosis, 1 case had CRN and 2 cases had NR.The prognosis was good in 2 cases of karyotype and 1 case of non-remission of none remissionn NRV, 3 cases of moderate karyotype and 1 case of CR2 cases of NRR with poor prognosis.In palliative group, there was no CR1, and early death was 14. 3% in 2 cases.The main causes of early death in both groups were severe pulmonary infection, cerebral hemorrhage, respiratory and circulatory failure.The median survival time of chemotherapy group was 5.8 months, the median survival time of palliative group was 2.5 months, the 1-year survival rate was 19.2% and 7.0%, and the 2-year survival rate was 15.4% and 0.00.The median survival time of chemotherapy group was higher than that of palliative treatment group (0.024%).The adverse reactions of induced chemotherapy group mainly included gastrointestinal reaction, bone marrow suppression, hemorrhage, pulmonary infection, abnormal liver function and abnormal cardiac function.Four of the patients died of severe complications.The adverse reactions of gastrointestinal tract, bone marrow suppression and hemorrhage in induced chemotherapy group were significantly higher than those in palliative group, and the difference was statistically significant (P 0.05).Conclusion: combined induction chemotherapy can prolong the median survival time of elderly patients with AML compared with palliative treatment.Elderly patients with poor tolerance, treatment of adverse reactions.
【学位授予单位】：安徽医科大学
【学位级别】：硕士
【学位授予年份】：2016
【分类号】：R733.71

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