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第 15 天骨髓驱动的年轻成人急性髓系白血病双重诱导:可行性、毒性和治疗结果。

Day 15 bone marrow driven double induction in young adult patients with acute myeloid leukemia: feasibility, toxicity, and therapeutic results.

机构信息

Division of Hematology and Stem Cell Transplantation Unit, Cardarelli Hospital, Via Nicolò Piccinni 6, Naples, Italy.

出版信息

Am J Hematol. 2010 Sep;85(9):687-90. doi: 10.1002/ajh.21791.

Abstract

The strategy named double induction (DI) in acute myeloid leukemia (AML) consists of two courses of chemotherapy irrespective of the degree of cytoreduction in the bone marrow (BM) after the first course, unless severe complications prohibit its application. We describe treatment results from a series of 33 patients in whom DI was adopted only after demonstration of persistence of more than 10% blast cells at day 15 (D15) examination of BM. All patients received as induction idarubicin, cytarabine, and etoposide. As second induction, we administered the combination of fludarabine, intermediate dose cytarabine, and Granulocyte colony stimulating factor (G-CSF). The median blast count at D15 was 30 (15-90). Overall, 30 of 33 patients were judged as eligible to receive DI, reasons for exclusion being in all cases active infection in the context of severe pancytopenia. Nineteen patients (63%) had unfavorable karyotype and 11 (37%) normal karyotype; seven of these had Fms-like tyrosine kinase gene internal tandem duplication (FLT3/ITD) mutation. Overall, complete remission (CR) was achieved in 20/30 patients (67%), while eight patients (27%) were refractory and two died of infectious complications. All refractory patients had unfavorable cytogenetics. All patients achieving CR were programmed to receive allogeneic stem cell transplantation (allo-SCT), which was actually performed in 11 patients. Our study suggest that D15 driven DI represents a feasible and effective therapeutic strategy in young adult AML patients, improving therapeutic results and not compromising feasibility of allo-SCT. When compared with conventional DI, it offers the potential to avoid unnecessary toxicity in a consistent proportion of patients.

摘要

双诱导(DI)策略用于急性髓系白血病(AML),无论第一疗程后骨髓(BM)的减细胞程度如何,均进行两个疗程的化疗,除非严重并发症禁止使用。我们描述了仅在 BM 检查 D15 时发现超过 10%的原始细胞持续存在的情况下采用 DI 的 33 例患者的治疗结果。所有患者均接受阿糖胞苷、依托泊苷联合伊达比星诱导治疗。作为二线诱导,我们采用氟达拉滨、中剂量阿糖胞苷联合粒细胞集落刺激因子(G-CSF)方案。D15 时的原始细胞中位数为 30(15-90)。总体而言,33 例患者中有 30 例符合接受 DI 的条件,排除的原因均为严重全血细胞减少症伴活动性感染。19 例(63%)患者存在不良核型,11 例(37%)患者核型正常;其中 7 例存在 Fms 样酪氨酸激酶基因内部串联重复(FLT3/ITD)突变。总体而言,30 例患者中有 20 例(67%)达到完全缓解(CR),8 例(27%)患者为难治性,2 例死于感染性并发症。所有难治性患者均具有不良核型。所有达到 CR 的患者均计划接受异基因造血干细胞移植(allo-SCT),实际上有 11 例患者进行了移植。我们的研究表明,D15 驱动的 DI 是年轻 AML 患者可行且有效的治疗策略,可改善治疗效果,且不影响 allo-SCT 的可行性。与常规 DI 相比,它具有在一定比例的患者中避免不必要毒性的潜力。

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