Lee Yun-Gyoo, Kwon Ji-hyun, Kim Inho, Yoon Sung Soo, Lee Jong-Seok, Park Seongyang
Department of Internal Medicine, Seoul National University College of Medicine, Seoul National University Bundang Hospital, Seongnam, Korea.
Eur J Haematol. 2014 Jun;92(6):478-84. doi: 10.1111/ejh.12274. Epub 2014 Mar 27.
This study aimed at evaluating the efficacy and toxicity of the combination regimen of high-dose cytarabine, etoposide and cisplatin (HAEP) in adult patients with high-risk relapsed or refractory acute myeloid leukaemia (AML).
From January 2001 to December 2012, 49 relapsed or refractory AML patients [36 men; 13 women; median age, 42 (range, 18-71) yr; patients aged >60 yr, 8] were treated with HAEP [high-dose cytarabine (2 g/m(2) ), etoposide (100 mg/m(2) ) and cisplatin (20 mg/m(2) ) for five alternative days] as salvage therapy. Patients who had the first relapse at <6 months after an initial complete remission (CR), had a second or subsequent relapse, were primary refractory to ≥2 courses of front-line conventional induction chemotherapy or were refractory to re-induction chemotherapy after any relapse was eligible for HAEP treatments.
The overall CR + CR without platelet recovery (CRp) rates among 49 evaluable patients were 31% [95% confidence interval (CI), 17-44%]. Of the eight patients aged ≥60 yr, none showed any response to HAEP treatment. The CR + CRp rate was 54% in patients with second or greater relapse and 25% in patients refractory to re-induction therapy after relapse. In multivariate analysis, younger age, favourable cytogenetics and no prior salvage chemotherapy were independent predictors for better responses.
Our findings suggest that HAEP is an effective salvage chemotherapy for patients aged <60 yr with high-risk relapsed or refractory AML.
本研究旨在评估大剂量阿糖胞苷、依托泊苷和顺铂联合方案（HAEP）对高危复发或难治性成人急性髓系白血病（AML）患者的疗效和毒性。
2001年1月至2012年12月，49例复发或难治性AML患者[36例男性；13例女性；中位年龄42岁（范围18 - 71岁）；年龄>60岁患者8例]接受HAEP[大剂量阿糖胞苷（2g/m²）、依托泊苷（100mg/m²）和顺铂（20mg/m²），交替使用5天]作为挽救治疗。初始完全缓解（CR）后6个月内首次复发、第二次或后续复发、对≥2疗程一线传统诱导化疗原发难治或任何复发后对再诱导化疗难治的患者符合HAEP治疗条件。
49例可评估患者的总CR + 未恢复血小板的CR（CRp）率为31%[95%置信区间（CI），17 - 44%]。8例年龄≥60岁的患者对HAEP治疗均无反应。第二次或更晚期复发患者的CR + CRp率为54%，复发后对再诱导治疗难治的患者为25%。多因素分析显示，年龄较小、细胞遗传学良好和未接受过挽救化疗是反应较好的独立预测因素。
我们的研究结果表明，HAEP对年龄<60岁的高危复发或难治性AML患者是一种有效的挽救化疗方法。
