中国综合临床
中國綜閤臨床
중국종합림상
CLINICAL MEDICINE OF CHINA
2010年
3期
285-288
,共4页
王茫桔%马明信%王颖%岑溪南%许蔚林%董玉君%李渊%邱志祥%欧晋平%任汉云
王茫桔%馬明信%王穎%岑溪南%許蔚林%董玉君%李淵%邱誌祥%歐晉平%任漢雲
왕망길%마명신%왕영%잠계남%허위림%동옥군%리연%구지상%구진평%임한운
急性髓细胞性白血病%粒细胞-集落刺激因子%阿糖胞苷%阿克拉霉素
急性髓細胞性白血病%粒細胞-集落刺激因子%阿糖胞苷%阿剋拉黴素
급성수세포성백혈병%립세포-집락자격인자%아당포감%아극랍매소
Acute myeloid leukemia%Granulocyte colony-stimulating factor%Cytarabine%Lacinomy-cin
目的 观察粒细胞-集落刺激因子(G-CSF)与小剂量AA方案组合(CAG方案),对急性髓细胞性白血病(AML)患者完全缓解率(CR)及总体生存(OS)、无病生存(DFS)时间的影响,并试图通过预后因素分析,确定CAG方案的最佳适合人群.方法 21例AML患者采用CAG预激方案治疗,即阿糖胞苷(Ara-C)10 mg/m~2,皮下注射,每12小时1次,第1～14天.阿克拉霉素(ACR)5～7 mg/m~2,静脉注射,每天1次,第1～8天.G-CSF 200μg/m~2,皮下注射,每天1次,在Ara-C之前12 h给予.结果 CAG方案在21例AML患者中总CR率66.7%(14/21),60岁以上患者CR率87.5%(7/8),难治复发患者CR率60.0%(9/15),骨髓增生异常综合征(MDS)转化的AML患者CR率83.3%(5/6).骨髓增生极度活跃与低下至明显活跃患者CR率分别为33.3%(3/9)、91.7%(11/12),差异有统计学意义(P=0.009).21例AML患者中位总体生存时间为450 d,2年生存率为30.6%,中位无痛生存时间为165 d.难治或复发患者中位总体生存时间为435 d.高危核型与标危、良好核型患者中位总体生存时间分别为140 d、620 d(P=0.001).骨髓增生极度活跃与低下至明显活跃患者中位总体生存时间分别为321 d、620 d(P=0.05).21例患者中性粒细胞(ANC)<1.0×10~9/L的中位时间8 d,持续发热中位时间3.5 d,按WHO的毒性标准>2级的感染发生率为42.9%,无早期死亡病例.结论 CAG预激方案可能提高难治复发AML、老年AML及继发于MDS的AML的CR率,延长难治复发患者的中位总体生存时间.发病时骨髓增生极度活跃患者及具有预后不良核型患者不能从CAG方案获益,应尝试其他方案治疗.CAG方案缩短粒细胞缺乏时间,严重感染发生率低,对于不耐受传统强烈化疗的患者值得考虑应用.
目的 觀察粒細胞-集落刺激因子(G-CSF)與小劑量AA方案組閤(CAG方案),對急性髓細胞性白血病(AML)患者完全緩解率(CR)及總體生存(OS)、無病生存(DFS)時間的影響,併試圖通過預後因素分析,確定CAG方案的最佳適閤人群.方法 21例AML患者採用CAG預激方案治療,即阿糖胞苷(Ara-C)10 mg/m~2,皮下註射,每12小時1次,第1～14天.阿剋拉黴素(ACR)5～7 mg/m~2,靜脈註射,每天1次,第1～8天.G-CSF 200μg/m~2,皮下註射,每天1次,在Ara-C之前12 h給予.結果 CAG方案在21例AML患者中總CR率66.7%(14/21),60歲以上患者CR率87.5%(7/8),難治複髮患者CR率60.0%(9/15),骨髓增生異常綜閤徵(MDS)轉化的AML患者CR率83.3%(5/6).骨髓增生極度活躍與低下至明顯活躍患者CR率分彆為33.3%(3/9)、91.7%(11/12),差異有統計學意義(P=0.009).21例AML患者中位總體生存時間為450 d,2年生存率為30.6%,中位無痛生存時間為165 d.難治或複髮患者中位總體生存時間為435 d.高危覈型與標危、良好覈型患者中位總體生存時間分彆為140 d、620 d(P=0.001).骨髓增生極度活躍與低下至明顯活躍患者中位總體生存時間分彆為321 d、620 d(P=0.05).21例患者中性粒細胞(ANC)<1.0×10~9/L的中位時間8 d,持續髮熱中位時間3.5 d,按WHO的毒性標準>2級的感染髮生率為42.9%,無早期死亡病例.結論 CAG預激方案可能提高難治複髮AML、老年AML及繼髮于MDS的AML的CR率,延長難治複髮患者的中位總體生存時間.髮病時骨髓增生極度活躍患者及具有預後不良覈型患者不能從CAG方案穫益,應嘗試其他方案治療.CAG方案縮短粒細胞缺乏時間,嚴重感染髮生率低,對于不耐受傳統彊烈化療的患者值得攷慮應用.
목적 관찰립세포-집락자격인자(G-CSF)여소제량AA방안조합(CAG방안),대급성수세포성백혈병(AML)환자완전완해솔(CR)급총체생존(OS)、무병생존(DFS)시간적영향,병시도통과예후인소분석,학정CAG방안적최가괄합인군.방법 21례AML환자채용CAG예격방안치료,즉아당포감(Ara-C)10 mg/m~2,피하주사,매12소시1차,제1～14천.아극랍매소(ACR)5～7 mg/m~2,정맥주사,매천1차,제1～8천.G-CSF 200μg/m~2,피하주사,매천1차,재Ara-C지전12 h급여.결과 CAG방안재21례AML환자중총CR솔66.7%(14/21),60세이상환자CR솔87.5%(7/8),난치복발환자CR솔60.0%(9/15),골수증생이상종합정(MDS)전화적AML환자CR솔83.3%(5/6).골수증생겁도활약여저하지명현활약환자CR솔분별위33.3%(3/9)、91.7%(11/12),차이유통계학의의(P=0.009).21례AML환자중위총체생존시간위450 d,2년생존솔위30.6%,중위무통생존시간위165 d.난치혹복발환자중위총체생존시간위435 d.고위핵형여표위、량호핵형환자중위총체생존시간분별위140 d、620 d(P=0.001).골수증생겁도활약여저하지명현활약환자중위총체생존시간분별위321 d、620 d(P=0.05).21례환자중성립세포(ANC)<1.0×10~9/L적중위시간8 d,지속발열중위시간3.5 d,안WHO적독성표준>2급적감염발생솔위42.9%,무조기사망병례.결론 CAG예격방안가능제고난치복발AML、노년AML급계발우MDS적AML적CR솔,연장난치복발환자적중위총체생존시간.발병시골수증생겁도활약환자급구유예후불량핵형환자불능종CAG방안획익,응상시기타방안치료.CAG방안축단립세포결핍시간,엄중감염발생솔저,대우불내수전통강렬화료적환자치득고필응용.
Objective To assess the effect of low-dose cytarabine and aclarubicin in combination with gran-ulocyte colony-stimulating factor (G-CSF) protocol (CAG) in patients with acute myeloid leukemia (AML),and to understand the potential factors affecting the outcome of CAG induction therapy, therefore to find the optimum pa-tients for CAG therapy. Methods Twenty-one AML patients were enrolled in the current study. All patients were treated with CAG regimen including cytarabine (10 mg/m~2, subcutaneously, every 12 h, days 1 - 14), lacinomycin (5～7 mg/m~2,intravenously,every day, days 1 -8) ,and G-CSF (200 μg/m~2,subcutaneously, every day,12 h be-fore Ara-C was given) priming. Results The overall complete remission (CR) rate of the 21 AML patients was 66.7% (14/21). The CR rates was 87.5% (7/8) in patients older than 60 yrs,60.0% (9/15) in the refractory or relapsed patients,83.3% (5/6) in the MDS transformed AML patients. The CR rates for patients with hyperprolif-erative BM and median to poor proliferative BM were 33.3% and 91.7% ,respectively(P =0.009). The median o-verall survival (OS) time of the 21 AML patients was 450 days. Two-year survival rate estimated by Kaplan-Meier Method was 30.6%. The overall median disease free survival (DFS) was 165 days. The median OS time for those refractory or relapsed was 435 days. The median OS time for those with poor cytogenetic state or standard or good cytogenetic state was 140 days and 620 days, respectively (P = 0.001). The median OS time for patients with hyperproliferative BM and median to poor proliferative BM was 321 days and 620 days, respectively (P = 0.05). The median recovery time of granulocytes above 1.0×10~9/L was 8 days. The median duration of fever was 3.5 days. The rate of infections exceeding WHO grade Ⅱ was 42.9%. No early death occurred. Conclusions The CAG induction therapy may have a higher CR rate in patients with refractory or relapsed AML, elderly AML and secondary AML from MDS transformation, and extend the median overall survival time in refractory or relapsed patients. CAG therapy can not improve the outcome of patients whose BM was in high grade proliferation state or whose cytogenetic state was poor. CAG therapy can shorten the duration of agranulocytosis and decrease the inci-dence of serious infection. Therefore, CAG therapy is worth recommending to patients who can not endure the rou-tine intensive chemotherapy.
