Xu Jianhui, Song Chaoyang, He Yanjie, Huang Rui, Tu Sanfang
Department of Hematology, Zhujiang Hospital of Southern Medical University, No. 253, Gongye Road, Haizhu District, Guangzhou, 510280, China.
Guangdong Engineering Research Center of Precision Immune Cell Therapy Technology, Zhujiang Hospital, No. 253, Gongye Road, Guangzhou, Haizhu District, 510282, China.
BMC Pharmacol Toxicol. 2025 Jan 20;26(1):10. doi: 10.1186/s40360-025-00839-w.
Few Chinese study compared the impacts of idarubicin and daunorubicin based "3+7" intensive chemotherapies on early and long-term outcomes of AML patients through exploring their real-world data.
Our none promyelocytic AML patients inducted with "3+7" regimens were studied to find out the factors relating with induction response and long term survival.
Idarubicin induction was related with less chemotherapy refractory rate comparing with daunorubicin induction (10% vs 25%, P = 0.02). But cytogenetic molecular risk classification was the only independent factor relating with achieving CR after initial induction or chemotherapy refractory (P = 0.000 and 0.036). Both to overall survival (OS) and progress free survival (PFS), having transplantation and chemotherapy refractory were independent factors related, MLL rearrangement and DNA methylating related genes' mutations as well. CR at time of transplantation and MLL rearrangement were independent factors relating both with OS after transplantation and relapse free survival after transplantation.
Traditional "3+7" chemotherapy regimen with idarubicin plays better in CR induction than that with daunorubicin. But the patient's long-term survival related with clinical practice aspects, like having stem cell transplantation, as well as genetic alterations equally, like MLL rearrangement and DNA methylating related genes' mutations.
很少有中国研究通过探索真实世界数据，比较基于伊达比星和柔红霉素的“3+7”强化化疗对急性髓系白血病（AML）患者早期和长期结局的影响。
我们对采用“3+7”方案诱导治疗的非早幼粒细胞性AML患者进行研究，以找出与诱导缓解和长期生存相关的因素。
与柔红霉素诱导相比，伊达比星诱导的化疗难治率更低（10%对25%，P = 0.02）。但细胞遗传学分子风险分类是与初次诱导后达到完全缓解（CR）或化疗难治相关的唯一独立因素（P = 0.000和0.036）。对于总生存期（OS）和无进展生存期（PFS）而言，进行移植和化疗难治都是相关的独立因素，MLL重排和DNA甲基化相关基因的突变也是如此。移植时的CR和MLL重排是与移植后OS和移植后无复发生存期均相关的独立因素。
含伊达比星的传统“3+7”化疗方案在CR诱导方面比含柔红霉素的方案效果更好。但患者的长期生存与临床实践因素如进行干细胞移植以及基因改变如MLL重排和DNA甲基化相关基因的突变同样有关。
