HAA方案治疗难治、复发老年急性髓系白血病的临床观察
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摘要
目的:探讨HAA方案治疗难治、复发老年急性髓系白血病(acute myeloid leukemia,AML)的疗效及毒副反应。方法:回顾性分析首次接受HAA方案(HHT 2. 0 mg/m~2qd,d_(1～7); Ara-C 100～200 mg/m~2qd,d_(1～7);Acla 12 mg/m~2qd,d_(1～7);根据情况调整具体天数)挽救治疗17例难治、复发老年AML患者的疗效及毒副反应,统计长期生存情况。结果:17例难治、复发老年AML患者中,3例达完全缓解(complete remission,CR),3例达部分缓解(partial remisson,PR),11例未缓解(none remisson,NR),临床有效率(CR+PR) 35. 3%。无1例患者出现早期死亡。中位生存时间为6. 2个月(0. 5～32. 0个月)。结论:HAA方案治疗难治、复发老年AML患者疗效与地西他滨方案相近,且安全性高,但由于样本量较小,需进一步开展多中心随机对照试验证实。
Objective: To explore the efficacy and side effects of HAA regimen for refractory and recurrent elderly patients of acute myeloid leukemia( AML). Methods: A retrospective analysis was performed on the efficiency and side effects of HAA regimen( HHT 2. 0 mg/m~2 qd,d_(1 ～ 7). Ara-C 100 ～ 200 mg/m~2 qd,d_(1 ～ 7). Acla 12 mg/m~2 qd,d_(1 ～ 7) for 17 elderly patients with refractory and recurrent AML. Results: Among the 17 elderly patients with refractory and recurrent AML,3 patients achieved complete remission( CR),3 patients achieved partial remission( PR),11 cases were none remission( NR). The clinical efficiency( CR + PR) was 35. 3%. None of the patients died early. Median survival time was 6. 2 months( 0. 5 ～ 32. 0 months). Conclusion: The efficacy of HAA regimen for refractory and recurrent elderly AML patients is close to decitabine regimen,and has high safety. Due to the small sample cohort,multicenter randomized controlled trial is necessary.
Objective: To explore the efficacy and side effects of HAA regimen for refractory and recurrent elderly patients of acute myeloid leukemia( AML). Methods: A retrospective analysis was performed on the efficiency and side effects of HAA regimen( HHT 2. 0 mg/m~2 qd,d_(1 ～ 7). Ara-C 100 ～ 200 mg/m~2 qd,d_(1 ～ 7). Acla 12 mg/m~2 qd,d_(1 ～ 7) for 17 elderly patients with refractory and recurrent AML. Results: Among the 17 elderly patients with refractory and recurrent AML,3 patients achieved complete remission( CR),3 patients achieved partial remission( PR),11 cases were none remission( NR). The clinical efficiency( CR + PR) was 35. 3%. None of the patients died early. Median survival time was 6. 2 months( 0. 5 ～ 32. 0 months). Conclusion: The efficacy of HAA regimen for refractory and recurrent elderly AML patients is close to decitabine regimen,and has high safety. Due to the small sample cohort,multicenter randomized controlled trial is necessary.
引文
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[16]Wang J,Lu S,Yang J,et al.A homoharringtonine-based induction regimen for the treatment of elderly patients with acute myeloid leukemia:A single center experience from China[J].J Hematol Oncol,2009,2:32.
[2]Burnett AK,Russell N,Hills RK,et al.A randomised comparison of the novel nucleoside analogue sapacitabine with low-dose cytarabine in older patients with acute myeloid leukaemia[J].Leukemia,2015,29(6):1312-1319.
[3]Chishti AH.Malaria selectively targets pregnancy receptors[J].Blood,2015,125(2):217-218.
[4]Stone RM,Berg DT,George SL,et al.Postremission therapy in older patients with de novo acute myeloid leukemia:A randomized trial comparing mitoxantrone and intermediate-dose cytarabine with standard-dose cytarabine[J].Blood,2001,98(3):548-553.
[5]Burnett AK.Treatment of acute myeloid leukemia:Are we making progress[J]?Hematology Am Soc Hematol Educ Program,2012,2012:1-6.
[6]Prebet T,Boissel N,Reutenauer S,et al.Acute myeloid leukemia with translocation(8;21)or inversion(16)in elderly patients treated with conventional chemotherapy:A collaborative study of the French CBF-AML intergroup[J].J Clin Oncol,2009,27(28):4747-4753.
[7]Jin J.Chinese guidelines for the diagnosis and treatment of relapsed and refractory acute myelogenous leukemia[J].Chinese Journal of Hematology,2011,32(12):887-888.
[8]Leukemia&Lymphoma Group,Chinese Society of Hematology,Chinese Medical Association.Chinese guidelines for diagnosis and treatment of adult acute myeloid leukemia(not APL)(2017)[J].Chinese Journal of Hematology,2017,38(3):177-182.
[9]Gao F,Du MZ,Li G,et al.Clinical observation of decitabine combined with low-dose HAG regimen in treatment of senile acute myeloid leukemia[J].Shaanxi Medical Journal,2018,47(2):231-234.[高飞,杜明珠,李光,等.地西他滨联合小剂量HAG方案治疗老年急性髓系白血病疗效研究[J].陕西医学杂志,2018,47(2):231-234.]
[10]Huang YQ,Zhang XY,Wu SX,et al.Curative effect of decitabine combined with iag regimen for senile patients with myelodysplastic syndrome(MDS)transformed acute myeloid leukemia[J].Journal of Experimental Hematology,2017,25(6):1641-1646.[黄月琴,张学亚,吴诗馨,等.地西他滨联合IAG方案治疗老年MDS转化为急性髓系白血病患者的疗效观察[J].中国实验血液学杂志,2017,25(6):1641-1646.]
[11]Zhou HW,Zhou MH,Wang ZH,et al.Clinical efficacy of decitabine combined with or without cytarabine-based low dose regimen for senile patients with acute myeloid leukemia[J].Journal of Experimental Hematology,2018,26(1):91-96.[周宏伟,周敏航,王志红,等.地西他滨单药或联合以阿糖胞苷为基础的低剂量化疗方案治疗老年急性髓系白血病的临床分析[J].中国实验血液学杂志,2018,26(1):91-96.]
[12]Kantarjian HM,Thomas XG,Dmoszynska A,et al.Multicenter,randomized,open-label,phaseⅢtrial of decitabine versus patient choice,with physician advice,of either supportive care or low-dose cytarabine for the treatment of older patients with newly diagnosed acute myeloid leukemia[J].J Clin Oncol,2012,30(21):2670-2677.
[13]Lubbert M,Ruter BH,Claus R,et al.A multicenter phaseⅡtrial of decitabine as first-line treatment for older patients with acute myeloid leukemia judged unfit for induction chemotherapy[J].Haematologica,2012,97(3):393-401.
[14]Wu D,Ye B,Shen J,et al.Observation of low-dose HA/HAAregimen as induction chemotherapy on elderly patients with acute myeloid leukemia[J].Chinese Journal of Hematology,2014,35(3):256-259.
[15]Ye P,Chen F,Mu Q,et al.The efficacy and safety of the reducing dose HAA regimen as induction chemotherapy in previously untreated elderly patients aged 60~69 years with acute myeloid leukemia[J].Chinese Journal of Hematology,2014,35(9):845-847.
[16]Wang J,Lu S,Yang J,et al.A homoharringtonine-based induction regimen for the treatment of elderly patients with acute myeloid leukemia:A single center experience from China[J].J Hematol Oncol,2009,2:32.