Saikia T K, Bakshi A, Bhagwat R, Tawde S, Nair R, Nair C N, Parikh P M
Department of Medical Oncology, Tata Memorial Hospital, Parel, Mumbai 400008, Maharashtra.
Natl Med J India. 2005 Jan-Feb;18(1):12-5.
There are little data from India on the management of acute myeloid leukaemia. With better understanding of the biology of the disease, and routine use of high-dose cytarabine as post-remission therapy with or without haematopoietic blood stem cell transplantation (HSCT), the results have improved in the past two decades. We analysed our results in a cohort of recently treated patients.
A total of 166 newly diagnosed patients with AML (excluding acute promyelocytic leukaemia), 15-60 years of age were treated with daunorubicin (60 mg/m2/day x3 days) or idarubicin (12 mg/m2/day x3 days) with cytarabine (100 mg/m2/day continuous i.v. infusion x7 days) induction chemotherapy. Post-remission therapy included 2 cycles of high-dose cytarabine (15-18 g/m2) followed by monthly cycles of outpatient maintenance chemotherapy x4 cycles, consisting of daunorubicin (45 mg/m2 i.v. x1 day and cytarabine 100 mg/ m2 s.c. twice daily x5 days). Six patients in remission received sibling donor allogeneic HSCT.
Morphological complete remission was achieved in 69.9% of the patients. Resistant disease after induction chemotherapy was seen in 14.6% and early mortality occurred in 16%. Relapse-free survival and event-free survival at a median of 36 months was 34% and 22%, respectively. Relapse occurred in 43.9%. The median duration of remission was 12 months.
Our results conform to the published literature from larger cooperative studies from the West. Currently available cytotoxic drugs are unlikely to improve the results any further.
印度关于急性髓系白血病治疗的数据较少。随着对该疾病生物学特性的深入了解，以及常规使用大剂量阿糖胞苷作为缓解后治疗（无论是否进行造血干细胞移植），在过去二十年中治疗结果有所改善。我们分析了一组近期接受治疗患者的结果。
总共166例年龄在15至60岁之间新诊断的急性髓系白血病患者（不包括急性早幼粒细胞白血病）接受了柔红霉素（60mg/m²/天×3天）或伊达比星（12mg/m²/天×3天）联合阿糖胞苷（100mg/m²/天持续静脉输注×7天）诱导化疗。缓解后治疗包括2个周期的大剂量阿糖胞苷（15 - 18g/m²），随后进行4个周期的门诊维持化疗，每月1次，由柔红霉素（45mg/m²静脉注射×1天）和阿糖胞苷（100mg/m²皮下注射，每日2次×5天）组成。6例缓解期患者接受了同胞供体异基因造血干细胞移植。
69.9%的患者实现了形态学完全缓解。诱导化疗后出现耐药疾病的比例为14.6%，早期死亡率为16%。中位随访36个月时，无复发生存率和无事件生存率分别为34%和22%。复发率为43.9%。缓解的中位持续时间为12个月。
我们的结果与西方大型合作研究发表的文献一致。目前可用的细胞毒性药物不太可能进一步改善治疗结果。
