Rassam S M, Turker A, Powles R L, Smith A G, Newland A C, Erskine J G, Pearce R M, Goldstone A H
Department of Haematology, University College Hospital, London, UK.
Semin Oncol. 1993 Dec;20(6 Suppl 8):13-9.
Ninety-eight adult patients with acute myeloid leukemia were given variable remission induction/consolidation regimens containing idarubicin. Sixty-nine (70%) were new cases (median age, 56 years) and 29 (30%) were in relapse (n = 24) or had primary refractory disease (n = 5) (median age, 46 years). Complete remission (CR) rates were 57% (39 of 69 patients) of the newly diagnosed patients, with no difference for those below or above 55 years of age (56% v 59%) or for patients exhibiting white blood cell counts of less or more than 50 x 10(9)/L (52% v 69%; P = .8). Of the 39 patients who achieved CR, 26 (67%, 38% of the total number of patients) remain in CR with a median follow-up of 3 months (range, 0 to 61 months). Forty-two percent of the relapsed cases (10 of 24 patients) and 60% of the primary refractory disease cases (three of five patients) achieved CR. Of these 13 responders, six are alive (three continuing in CR and three relapsed) with a median follow-up of 3 months (range, 1 to 20 months), and seven have died with a median survival of 7 months (range, 0 to 12 months). Of the 52 patients who have achieved CR, 84% did so with one course of treatment and 16% with two courses. The presence of normal cytogenetic analysis or favorable chromosomal aberrations significantly improved overall CR rates. The patients in this study had significantly more unfavorable cytogenetic abnormalities than the historic controls. Reported toxicity was hepatic in 13%, cardiac in 9%, and renal in 7% of all cases. These data suggest a comparable efficacy of idarubicin to other anthracyclines in remission induction of acute myeloid leukemia, with a promising role in relapsed/refractory disease.
98例成年急性髓系白血病患者接受了含去甲氧柔红霉素的不同缓解诱导/巩固治疗方案。69例（70%）为新发病例（中位年龄56岁），29例（30%）为复发患者（n = 24）或原发性难治性疾病患者（n = 5）（中位年龄46岁）。新诊断患者的完全缓解（CR）率为57%（69例患者中的39例），55岁及以下或以上患者的CR率无差异（56%对59%），白细胞计数低于或高于50×10⁹/L的患者的CR率也无差异（52%对69%；P = 0.8）。在达到CR的39例患者中，26例（67%，占患者总数的38%）仍处于CR状态，中位随访时间为3个月（范围0至61个月）。42%的复发患者（24例患者中的10例）和60%的原发性难治性疾病患者（5例患者中的3例）达到CR。在这13例缓解者中，6例存活（3例持续处于CR状态，3例复发），中位随访时间为3个月（范围1至20个月），7例死亡，中位生存期为7个月（范围0至12个月）。在52例达到CR的患者中，84%经一个疗程治疗达到CR，16%经两个疗程治疗达到CR。正常细胞遗传学分析或有利的染色体畸变的存在显著提高了总体CR率。本研究中的患者比历史对照有更多不利的细胞遗传学异常。报告的毒性在所有病例中肝脏毒性占13%，心脏毒性占9%，肾脏毒性占7%。这些数据表明，去甲氧柔红霉素在急性髓系白血病缓解诱导方面与其他蒽环类药物疗效相当，在复发/难治性疾病中具有良好前景。
