诱导治疗采用 7+3 方案后，中剂量阿糖胞苷巩固治疗对年轻低危急性髓系白血病患者的复发风险较高：一项回顾性多中心分析和文献综述

High risk of relapse with intermediate dose cytarabine for consolidation in young favourable-risk acute myeloid leukaemia patients following induction with 7+3: a retrospective multicentre analysis and critical review of the literature.

机构信息

Division of Hematology, Oncology, Blood and Marrow Transplantation, University of Minnesota, Minneapolis, USA.

Department of Haematology, Singapore General Hospital, Singapore, Singapore.

出版信息

Br J Haematol. 2021 Jul;194(1):140-144. doi: 10.1111/bjh.17462. Epub 2021 Apr 11.

DOI:10.1111/bjh.17462

PMID:33843048

Abstract

Following the 2017 European LeukemiaNet (ELN) guidelines, we changed our practice from using high-dose cytarabine (HIDAC-3 g/m q12h-D1,3,5) to intermediate-dose cytarabine (IDAC-1·5 g/m q12h-D1,3,5/D1-3) for consolidation in young(<60 years) favourable-risk acute myeloid leukaemia (AML) patients. We assessed the clinical impact of this practice change. Of 80 patients, 51 received HIDAC prior to the protocol change, and subsequently, 29 received IDAC. The three-year risk of relapse was significantly higher with IDAC [61%; 95% confidence interval (CI) 40-82] compared with HIDAC (22%; 10-34), P < 0·01. Our findings suggest HIDAC, rather than IDAC, is the preferred dose for single-agent cytarabine consolidation in young, favourable-risk AML following 7+3 induction.

摘要

根据 2017 年欧洲白血病网络（ELN）指南，我们改变了实践方案，将年轻（<60 岁）低危急性髓系白血病（AML）患者巩固治疗中的高剂量阿糖胞苷（HIDAC-3 g/m q12h-D1,3,5）改为中剂量阿糖胞苷（IDAC-1·5 g/m q12h-D1,3,5/D1-3）。我们评估了这一实践改变的临床影响。在 80 名患者中，51 名患者在方案改变前接受 HIDAC，随后 29 名患者接受 IDAC。IDAC 组的三年复发风险显著高于 HIDAC 组[61%；95%置信区间（CI）40-82]比 HIDAC（22%；10-34），P<0·01。我们的研究结果表明，在 7+3 诱导后，对于年轻、低危 AML 患者，与 IDAC 相比，HIDAC 是单药阿糖胞苷巩固治疗的首选剂量。