Farag Sherif S, Ruppert Amy S, Mrózek Krzysztof, Mayer Robert J, Stone Richard M, Carroll Andrew J, Powell Bayard L, Moore Joseph O, Pettenati Mark J, Koduru Prasad R K, Stamberg Judith, Baer Maria R, Block Annemarie W, Vardiman James W, Kolitz Jonathan E, Schiffer Charles A, Larson Richard A, Bloomfield Clara D
Division of Hematology and Oncology, Department of Internal Medicine, The Ohio State University, A433A Starling-Loving Hall, 320 W Tenth Avenue, Columbus, OH 43210, USA.
J Clin Oncol. 2005 Jan 20;23(3):482-93. doi: 10.1200/JCO.2005.06.090. Epub 2004 Nov 8.
Evaluate the outcome of induction and postremission therapy in adults younger than 60 years with normal cytogenetics acute myeloid leukemia (AML).
In 490 patients, induction included cytarabine and daunorubicin (AD) or cytarabine and escalated doses of daunorubicin and etoposide +/- PSC-833 (ADE/ADEP). Intensification included one cycle of high-dose cytarabine (HDAC) followed by etoposide/cyclophosphamide and mitoxantrone/diaziquone (group I), three HDAC cycles (group II), four intermediate-dose cytarabine (IDAC) or HDAC cycles (group III), or one HDAC/etoposide cycle and autologous stem-cell transplantation (ASCT; group IV).
Of 350 patients receiving AD, 73% achieved complete remission (CR), compared with 82% of 140 receiving ADE/ADEP (P = .04). Splenomegaly was associated with a lower CR rate (P < .001), and ADE/ADEP, with a higher CR rate in younger patients (P = .005). The 5-year disease-free survival (DFS) rate was 28% each for intensification groups I and II, compared with 41% and 45% for groups III and IV, respectively (P = .02). The 5-year cumulative incidence of relapse (CIR) was 62% and 67% for groups I and II, respectively, compared with 54% and 44% for groups III and IV, respectively (P = .049). The type of postremission intensification remained significant for DFS and CIR in multivariable analysis.
In younger adults with normal cytogenetics AML, splenomegaly predicts a lower CR rate, and the postremission strategies of either four cycles of I/HDAC or one cycle of HDAC/etoposide followed by ASCT are associated with improved DFS and reduced relapse compared with therapies that include fewer cycles of cytarabine or no transplantation.
评估细胞遗传学正常的60岁以下成人急性髓系白血病（AML）诱导缓解和缓解后治疗的结果。
490例患者的诱导治疗包括阿糖胞苷联合柔红霉素（AD）或阿糖胞苷联合递增剂量的柔红霉素及依托泊苷±PSC-833（ADE/ADEP）。强化治疗包括一个高剂量阿糖胞苷（HDAC）周期，随后是依托泊苷/环磷酰胺和米托蒽醌/二氮嗪醌（I组），三个HDAC周期（II组），四个中剂量阿糖胞苷（IDAC）或HDAC周期（III组），或一个HDAC/依托泊苷周期及自体干细胞移植（ASCT；IV组）。
350例接受AD治疗的患者中，73%达到完全缓解（CR），而140例接受ADE/ADEP治疗的患者中这一比例为82%（P = 0.04）。脾肿大与较低的CR率相关（P < 0.001），ADE/ADEP治疗在年轻患者中CR率较高（P = 0.005）。I组和II组强化治疗的5年无病生存率（DFS）均为28%，而III组和IV组分别为41%和45%（P = 0.02）。I组和II组的5年累积复发率（CIR）分别为62%和67%，而III组和IV组分别为54%和44%（P = 0.049）。在多变量分析中，缓解后强化治疗的类型对DFS和CIR仍有显著影响。
在细胞遗传学正常的年轻成人AML患者中，脾肿大预示较低的CR率，与包含较少阿糖胞苷周期或无移植的治疗相比，四个周期的I/HDAC或一个HDAC/依托泊苷周期随后进行ASCT的缓解后策略与改善的DFS和降低的复发相关。
