CAJ | 학술논문

目的研究米托蒽醌联合替尼泊苷(MT)方案在急性单核细胞白血病(M5)诱导缓解中的疗效及患者不良反应,并观察疗效与白血病染色体核型的关系.方法将33例M5患者按治疗史分两组:初治组23例(A组)、DA(柔红霉素联合阿糖胞苷)或HDA(三尖杉酯碱、柔红霉素和阿糖胞苷)1个疗程无效组10例(B组).按核型预后分两组:预后中等组29例(C组),预后不良组4例(D组),均采用MT方案2个疗程诱导缓解,分别统计4组的临床疗效及患者不良反应.结果 MT方案对A、B组的M5诱导完全缓解(CR)率分别为83%(19/23)及60%(6/10),有效率达91%(21/23)及70%(7/10).C、D组CR率分别为83%(24/29)及25%(1/4),有效率为88%(26/29)及50%(2/4),其中复杂核型CR率为0(0/3),非复杂核型的11q23染色体异常患者一次化疗达CR率100%(4/4).MT方案对M5化疗后白细胞最低点在第(7±3)天出现,为(0.4±0.2)×109/L,白细胞<1×109/L时间达(8±5)d,未见化疗相关死亡病例.结论 MT方案简单有效、较安全,是治疗M5的较佳化疗方案,对1个疗程DA、HDA方案无效者亦可试用.MT方案化疗疗效与核型预后分组有关,对11q23染色体异常的M5患者疗效较好,对复杂核型患者疗效欠佳.
목적 연구미탁은곤연합체니박감(MT)방안재급성단핵세포백혈병(M5)유도완해중적료효급환자불량반응,병관찰료효여백혈병염색체핵형적관계.방법 장33례M5환자안치료사분량조:초치조23례(A조)、DA(유홍매소연합아당포감)혹HDA(삼첨삼지감、유홍매소화아당포감)1개료정무효조10례(B조).안핵형예후분량조:예후중등조29례(C조),예후불량조4례(D조),균채용MT방안2개료정유도완해,분별통계4조적림상료효급환자불량반응.결과 MT방안대A、B조적M5유도완전완해(CR)솔분별위83%(19/23)급60%(6/10),유효솔체91%(21/23)급70%(7/10).C、D조CR솔분별위83%(24/29)급25%(1/4),유효솔위88%(26/29)급50%(2/4),기중복잡핵형CR솔위0(0/3),비복잡핵형적11q23염색체이상환자일차화료체CR솔100%(4/4).MT방안대M5화료후백세포최저점재제(7±3)천출현,위(0.4±0.2)×109/L,백세포<1×109/L시간체(8±5)d,미견화료상관사망병례.결론 MT방안간단유효、교안전,시치료M5적교가화료방안,대1개료정DA、HDA방안무효자역가시용.MT방안화료료효여핵형예후분조유관,대11q23염색체이상적M5환자료효교호,대복잡핵형환자료효흠가.
Objective To evaluate the effectiveness and side effect of MT regimen (mitoxantrone plus teniposide) in inductive chemotherapy and explore the relationship between the effectiveness and karyotype. Methods 33 patients with acute monocytic leukemia were divided into two groups according to the treatment history or risk status according to cytogenetics MRC criteria. Group A (n=23) and B (n=10) were primary treatment and no remission following one course of DA (daunorubicin plus cytarabine) or HDA (Harringtonine,daunorubicin plus cytarabine) regimen,respectively. According to MRC criteria,group C (n=29) and D (n=4) were intermediate and adverse group. All the cases received two courses MT regimen chemotherapies to induce remission. The results and side effects were analysed. Results The complete remission rate and effective rate in group A and B were 83 % (19/23) and 60 % (6/10),91 % (21/23) and 70 % (7/10) respectively. The complete remission rate and effective rate in group C and D was 83 % (24/29) and 25 % (1/4),88 % (26/29) and 50 % (2/4) respectively. In complex cytogenetic group and 11q23 abnormal without complex cytogenetic group,CR rate was 0 (0/3) and 100 % (4/4). The time point,count of WBC nadir and the duration of WBC were less than 1×109/L is (7±3) day after chemotherapy,(0.4±0.2)×l09/L,(8±5) day. Chemotherapy related mortality was 0. Conclusion MT regimen was highly effective and safe in inducing remission in acute monocytic leukemia,including the cases which achieved no remission following one course of DA or HDA regimen. The effectiveness of MT regimen relates to the cytogenetics. MT regimen may be highly effective in cases with 11q23 abnormal and poor effective in cases with complex cytogenetic.