Xu Jun, Lv Ting-Ting, Zhou Xiao-Fen, Huang Ying, Liu Dong-Dong, Yuan Guo-Lin
Department of Hematology, Xiangyang Central Hospital, The Affiliated Hospital of Hubei University of Arts and Science, Xiangyang, China.
Medicine (Baltimore). 2018 Sep;97(39):e12102. doi: 10.1097/MD.0000000000012102.
To assess treatment response and overall survival (OS) in refractory or relapsed acute myeloid leukemia (R/R AML) patients treated by different common salvage chemotherapy regimens.Medical records data from 142 R/R AML patients were reviewed in this retrospective study. Patients were treated with regimens based on the following drugs: cytarabine, granulocyte colony-stimulating factor (G-CSF), and fludarabine (FLAG) (n = 46); cytarabine and G-CSF in addition to aclarubicin or daunorubicin (CAG/DAG) (n = 30); cytarabine, G-CSF, and cladribine (CLAG) (n = 27); cytarabine, etoposide, and mitoxantrone (MEA) (n = 17); cytarabine plus idarubicin, daunorubicin, or mitoxantrone (IA/DA/MA) (n = 12); and homoharringtonine, cytarabine, and aclarubicin or daunorubicin (HAA/HAD) (n = 10).A total of 43 (35.2%) patients achieved complete remission (CR), 60 (49.2%) patients achieved overall remission rate (ORR), and 18 (14.8%) patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CR. Median OS was 8.0 (95% CI 6.6-9.4) months with a 1-year OS rate of (29.9 ± 3.9)% and 3-year OS rate of (11.1 ± 3.6)%. No difference of CR (P = .621), ORR (P = .385), and allo-HSCT (P = .537) achievement was observed among different chemotherapy regimens. Interestingly, we observed that the CLAG-based regimen did not affect CR (P = .165), while it achieved a numerically higher ORR (P = .093) and was an independent factor for prolonged OS (P = .016). No other regimens were determined to be correlated with CR, ORR, or OS.FLAG-, CAG/DAG-, CLAG-, MEA-, IA/DA/MA- and HAA/HAD-based regimens were found to achieve similar CR rates, while the CLAG-based regimen achieved numerically higher ORR rates and significant favorable OS. Therefore, CLAG-based regimens should be a prioritized treatment option for R/R AML patients.
评估不同常见挽救性化疗方案治疗难治性或复发性急性髓系白血病（R/R AML）患者的治疗反应和总生存期（OS）。在这项回顾性研究中，对142例R/R AML患者的病历数据进行了审查。患者接受了基于以下药物的方案治疗：阿糖胞苷、粒细胞集落刺激因子（G-CSF）和氟达拉滨（FLAG）（n = 46）；阿糖胞苷和G-CSF加阿克拉霉素或柔红霉素（CAG/DAG）（n = 30）；阿糖胞苷、G-CSF和克拉屈滨（CLAG）（n = 27）；阿糖胞苷、依托泊苷和米托蒽醌（MEA）（n = 17）；阿糖胞苷加伊达比星、柔红霉素或米托蒽醌（IA/DA/MA）（n = 12）；高三尖杉酯碱、阿糖胞苷和阿克拉霉素或柔红霉素（HAA/HAD）（n = 10）。共有43例（35.2%）患者达到完全缓解（CR），60例（49.2%）患者达到总缓解率（ORR），18例（14.8%）患者在CR后接受了异基因造血干细胞移植（allo-HSCT）。中位OS为8.0（95%CI 6.6 - 9.4）个月，1年OS率为（29.9±3.9）%，3年OS率为（11.1±3.6）%。不同化疗方案之间在CR（P = 0.621）、ORR（P = 0.385）和allo-HSCT（P = 0.537）达成情况方面未观察到差异。有趣的是，我们观察到基于CLAG的方案不影响CR（P = 0.165），而其ORR在数值上更高（P = 0.093），并且是OS延长的独立因素（P = 0.016）。未确定其他方案与CR、ORR或OS相关。基于FLAG、CAG/DAG、CLAG、MEA、IA/DA/MA和HAA/HAD的方案达到了相似的CR率，而基于CLAG的方案在数值上达到了更高的ORR率和显著良好的OS。因此，基于CLAG的方案应是R/R AML患者的优先治疗选择。
