中国医科大学学报

中国医科大学学报
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中国医科大学学报 ›› 2018, Vol. 47 ›› Issue (6): 494-498.doi: 10.12007/j.issn.0258‐4646.2018.06.004

• 论著 • 上一篇    下一篇

初次诱导失败急性髓性白血病患者不同序贯诱导方案治疗的疗效观察

杨融辉, 沈静, 张萌, 马欢欣, 廖爱军   

  1. 中国医科大学附属盛京医院第二血液内科, 沈阳 110004
  • 收稿日期:2018-01-22 出版日期:2018-06-30 发布日期:2018-05-29
  • 通讯作者: 廖爱军 E-mail:liaoaj@sj-hospital.org
  • 作者简介:杨融辉(1993-),女,硕士研究生.
  • 基金资助:
    国家自然科学基金(81272629);沈阳市科学技术计划(17-231-1-58)

Therapeutic Effect of Different Sequential Induction Therapy Regimens for First Induction Failure in Acute Myeloid Leukemia

YANG Ronghui, SHEN Jing, ZHANG Meng, MA Huanxin, LIAO Aijun   

  1. Department of Hematology, Shengjing Hospital, China Medical University, Shenyang 110004, China
  • Received:2018-01-22 Online:2018-06-30 Published:2018-05-29

摘要: 目的 分析急性髓性白血病(AML)初次诱导治疗失败后序贯CAG或非CAG诱导方案治疗的疗效及安全性。方法 回顾2011年6月至2017年12月本科室收治初诊AML经常规标准诱导化疗失败的63例患者(患者均于初次诱导停止化疗后7~10 d复查骨髓穿刺,骨髓幼稚细胞>5%),根据追加诱导方案的不同分为CAG组(n=39)及非CAG组(n=24)。所有患者治疗前均签署知情同意书。CAG组方案:阿柔比星(20 mg/d,4 d)+阿糖胞苷(Ara-C,15~20 mg/12 h,14 d)+G-CSF (5 μg·kg-1·d-1,14 d),白细胞>20×109/L暂停使用G-CSF;非CAG组方案:追加原诱导方案、单用蒽环类药物、蒽环类+Ara-C或HAG方案。参照NCCN 2017年AML诊疗指南对患者疗效进行评价。结果 CAG组患者完全缓解(CR)66.67%、有效率(ORR)76.92%,非CAG组CR 25.00%、ORR 62.50%,2组间CR差异具有统计学意义(P<0.05),但ORR差异不具有统计学意义(P>0.05)。中、高危患者经CAG与非CAG方案治疗后疗效具有统计学差异(P<0.05)。与非CAG组比较,CAG组骨髓抑制时间相对较短,输注血小板次数相对较少(均P<0.05)。CAG组非血液学不良反应明显低于非CAG组(P<0.05)。结论 序贯CAG诱导方案治疗初次诱导失败的AML疗效较好,有效提高中、高危患者CR及ORR,安全性较高,推荐临床应用。

关键词: 急性髓性白血病, 初次诱导失败, 序贯诱导治疗, CAG

Abstract: Objective To retrospectively analyze the efficacy of sequential cytarabine, aclarubicin, and granulocyte colony-stimulating factor (CAG) or non-CAG induction regimens in the treatment of acute myeloid leukemia (AML) after initial induction failure. Methods Newly diagnosed AML patients who experienced failure of initial routine standard inductive chemotherapy between June 2011 and December 2017 in the hematology department of the Shengjing Hospital were divided into a CAG group (n=39) and non-CAG group (n=24). All patients gave informed consents before therapy. Regimen details of the CAG group are as follows:aclarubicin 20 mg/d, 4 d;cytarabine (Ara-C) 15-20 mg/12 h, 14 d;granulocyte colony-stimulating factor (G-CSF) 5 μg·kg-1·d-1, 14 d (suspend G-CSF when white blood cells >20×109/L). The non-CAG group received an additional primary induction scheme with anthracycline monotherapy;homoharringtonine, cytarabine, and G-CSF;or other agents. Results The complete remission rate was higher for the CAG than for the non-CAG regimen (66.67% vs. 25.00%, P<0.05). No differences in objective response rate were observed (76.92% vs. 62.50%, P>0.05). The duration of bone marrow inhibition was much shorter and the need for platelet transfusion was decreased in the CAG group (P<0.05). The CAG regimen produced fewer hematological and non-hematological side effects than the non-CAG regimen (P>0.05). Conclusion Sequential inductive chemotherapy with CAG had better efficacy and high safety and is recommended for clinical application.

Key words: acute myeloid leukemia, first induction failure, sequential induction therapy, CAG

中图分类号: 

  • R733.71
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[1] 高然,张蕊,于锦香,高峰,蔡大利,王柏勋,潘登,颜晓菁,李艳. 地西他滨联合半量CAG方案治疗老年和(或)复发难治性急性髓细胞白血病的疗效分析[J]. 中国医科大学学报, 2013, 42(6): 515-517.
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