Battista R, Bassan R, D'Emilio A, Dragone P, Viero P, Dini E, Barbui T
Division of Haematology, Ospedali Riuniti, Bergamo, Italy.
Hematol Oncol. 1991 Jan-Feb;9(1):43-52. doi: 10.1002/hon.2900090106.
One hundred and ninety two adults (median age 44 years) with de novo or secondary (n = 17) acute myelogenous leukemia (AML) were managed with a maximum of six intended courses with adriamycin 25 mg/m2/d for three days, plus cytarabine 200 mg/m2/d and 6-thioguanine 200 mg/m2/d for seven days (short-term therapy, STT). Twenty eight patients not in remission after the first course were given cytarabine 2 g/m2/bd for six days, a treatment that was highly toxic and gave a low CR rate. One hundred and twenty-six patients overall (66 per cent) achieved a complete remission (CR), 117/164 (71 per cent) after one to three standard courses (median 1), and 9/28 (32 per cent) after high-dose cytarabine. Median CR duration was 12 months. By multivariate analysis, younger age, blast count less than or equal to 50 x 10(9)/L, and de novo AML were associated with a better outcome (p less than 0.05). CR duration correlated favourably with FAB M3 morphology and total number (five or six) of cycles (p less than 0.05). In patients receiving five or six total courses, median CR length resulted 15.5 months and leukemia-free survival at 3 years 37 per cent. Therapy was curtailed in one fourth of CR patients because of unacceptable toxicity, and there were nine early deaths attributable to therapy-related complications among 126 CR cases. STT may be a worthwhile form of treatment for patients with de novo non-hyperleukocytic AML that are able to tolerate five or six consecutive induction-like chemotherapy courses.
192例初发或继发（n = 17）急性髓系白血病（AML）成人患者（中位年龄44岁）接受了最多六个疗程的治疗，采用阿霉素25 mg/m²/d，连用三天，加用阿糖胞苷200 mg/m²/d和6-硫鸟嘌呤200 mg/m²/d，连用七天（短期治疗，STT）。28例在第一个疗程后未缓解的患者接受了阿糖胞苷2 g/m²/每日两次，连用六天的治疗，该治疗毒性很大且完全缓解率低。总体上126例患者（66%）获得完全缓解（CR），164例中的117例（71%）在一至三个标准疗程后（中位疗程1个）获得缓解，28例中的9例（32%）在接受大剂量阿糖胞苷治疗后获得缓解。CR的中位持续时间为12个月。多因素分析显示，年龄较轻、原始细胞计数小于或等于50×10⁹/L以及初发AML与较好的预后相关（p<0.05）。CR持续时间与FAB M3形态以及总疗程数（五个或六个）呈良好相关性（p<0.05）。在接受五个或六个总疗程治疗的患者中，CR的中位长度为15.5个月，3年无白血病生存率为37%。四分之一的CR患者因不可接受的毒性而中止治疗，在126例CR病例中有9例因治疗相关并发症而早期死亡。对于能够耐受五个或六个连续诱导样化疗疗程的初发非高白细胞性AML患者，STT可能是一种值得尝试的治疗方式。
