IA与DA方案诱导化疗初治急性髓系白血病疗效比较.docx

摘要
对于高白细胞患者在给予诱导化疗之前,予羟基脲以降低白细胞负荷,为
预防尿酸升高引起急性肾功能损害及肿瘤溶解综合征,化疗同时给予水化、碱
化等处理。
结果:
IA、DA 组 1 疗程完全缓解率各为 %(42/63)及 %(28/58),两组组间
比较提示 IA 组优于 DA 组(P =)。在细胞遗传学危险分层高危预后组两
组例数较少,难以进行统计学分析。在中危组,IA 方案组的 CR 率及总有效率
均好于 DA 方案组,两组组间差异明显( P <)。在细胞遗传学良好预后组
中,IA 组的 CR 率及总有效率略好于 DA 组,但两组间无明显差异。在高白细
胞组中,IA 方案组好于 DA 方案组,两组组间差异明显(P =)。在非高
白细胞组中,两组组间无明显差异。在治疗 AML 患者 M5 型中,IAE 方案相比
IA 方案,完全缓解率稍高,但两组病例组间比较差异不明显(P=),两组
病例的总有效率无明显差异。追加方案组与 IA 方案比较,前者完全缓解率稍高,
但两组组间差异无明显差异(P=),两组病例的总有效率亦无明显差异。
两组主要的毒副作用均是骨髓抑制、感染、恶心呕吐等。
结论:
1、IA 方案比 DA 方案有更好的临床疗效。
2、IA 方案相比 DA 方案,在预后中等组及初治高白细胞组中均有较好的疗
效,前者也是目前最佳诱导缓解方案之一。
3、IAE 方案和 IA 方案,在治疗 AML 患者 M5 型中均有较好的疗效。
4、在 IA 方案诱导化疗未完全缓解时,立即行单用阿糖胞苷或 CAG 方案追
加化疗可进一步提高患者完全缓解率。
5、两组方案化疗期间及化疗后的支持治疗很重要。
关键词:急性髓系白血病,去甲氧柔红霉素,柔红霉素,阿糖胞苷,诱导
治疗,完全缓解率
III
Abstract
ABSTRACT
Background:
Acute myeloid leukemia (AML) is a highly heterogeneous bone marrow
hematopoietic system abnormal proliferation of hematological malignancies. Its main
characteristic is that a large number of myeloid progenitor cells and immature cells
proliferation and extensive destruction or an infiltration, incidence
of dangerous with a very poor prognosis.
At present, it is widely used clinical treatment of acute myeloid leukemia is
classic anthracene ring "3 + 7" drugs and bined induction regimen,
with a large number of new drug research and development, gradual optimization of
treatment, chemotherapy also supplemented with ponents, a wide range of
antibiotic use symptomatic support treatment, the curative effect of patients with
AML were improved obviously. Domestic and foreign research shows, patients
complete remission(CR) rate can reach 65%-85%. ics, immunology, initial
white blood cell count and age of the prognosis related factors of AML treatment
stratification provides the guidance of treatment. At this stage, induced treatment of
acute myeloid leukemia two anthracycline drugs, to the idarubicin and daunorubicin,
both has been