摘要
Abstract
Objective To analyse the short-term and long-term efficacy of high-dose Dauaorubicin (DNR) combined with standard dose cytarabine (Ara-C) in young and middle-aged patients with acute myeloid leukemia (AML).Methods Totally 133 young and middle-aged patients with newly diagnosed AML received high-dose [60mg/(m2·d)] DNR combined with standard dose [100mg/(m2·d)] of Ara-C from January 2011 to May 2015 were enrolled for study in observation group.And 125 young and middle-aged patients with newly diagnosed AML received standard dose DA induction therapy [45 mg/(m2·d) DNR combined with 100mg/(m2·d) Ara-C] during the same period were randomly selected for study in control group.Complete remission (CR) rate,the incidence of adverse reactions,early mortality,duration of reduction of blood absolute neutrophil count (ANC) and PLT were compared between the two groups.All cases were followed up until December 2016.1-,2-,3-year overall survival (OS) and disease-free survival (DFS) were compared between the two groups.Univariate and multivariate Cox proportional hazard model were used to screen out the independent related factors for OS and DFS of patients reached CR in the observation group.Results There were no statistically significant differences in baseline data before treatment between the two groups (P＞ 0.05).The CR rates after 1 course of induction chemotherapy in the observation group and the control group were 67.7％ and 57.6％,respecfively and there was no significant difference between them (P ＞ 0.05).The total CR rate after 2 courses in the observation group was 82.0％ which was significantly higher than 70.4％ in the control group (P ＜ 0.05).There were no significant differences in the incidences of all adverse reactions,early mortality,duration of ANC and PLT reduction between the two groups (P ＞ 0.05).Researching CR after induction chemotherapy,103 cases (95％) and 84 cases (67.2％) in the two groups received 1-4 courses of consolidation chemotherapy,then 21 cases (15.8％) and 17 cases (13.6％) underwent allogeneic hematopoietic stem cell transplantation,2 cases (1.5％) and 1 case (0.8％) underwent autologous hematopoietic stem cell transplantation.At the end of the last follow-up,the median follow-up time was 26.8 months and 28 months in the two groups.There were no statistically significant differences in 1-,2-and 3-year OS or DFS after chemotherapy between the two groups (P ＞ 0.05).Multivariate Cox regression analysis results showed that for the 109 cases of patients reached CR after induction chemotherapy in the observation group,prognostic risk stratification and receiving more than 2 courses of high-dose Ara-C consolidation chemotherapy were the independent related factors of OS (P＜ 0.05),and prognostic risk stratification and FLT3-ITD mutation were the independent related factors of DFS (P ＜ 0.05).Conclusions Compared with standard dose DNR,high-dose DNR combined with standard dose Ara-C can significantly improve the CR rate in young and middle-aged patients with AML and does not increase the risks of adverse reactions,but there is no obvious advantage in improvement of long-term survival.关键词
柔红霉素/急性髓系白血病/不同剂量/阿糖胞苷/预后Key words
Daunorubicin/acute myeloid leukemia/different dosage/Cytarabine/prognosis分类
医药卫生
