Lambertenghi Deliliers G, Annaloro C, Oriani A, Pozzoli E, Cortelezzi A, Cortellaro M, Mozzana R, Della Volpe A, Soligo D, Cofrancesco E
Istituto di Scienze Mediche, University of Milan, Italy.
Semin Oncol. 1993 Dec;20(6 Suppl 8):27-33.
Fifty-seven previously untreated adult acute myeloid leukemia patients received idarubicin (IDA) in sequential combination with cytarabine as induction therapy; post-remission treatment included two courses of IDA and cytarabine alternating with two courses of VP-16 and cytarabine. As late intensification, patients received either high-dose cytarabine or, in 10 cases, autologous bone marrow transplantation. Complete remission (CR) was achieved in 48 patients (84.2%), 41 after one induction course and seven after two courses. Median length of disease-free survival (DFS) was 26 months. Univariate analysis did not identify any of the investigated variables as having prognostic significance in predicting DFS. On the other hand, patients achieving CR after one induction course had a better DFS than those requiring two courses. Furthermore, the analysis of DFS slightly favors autologous bone marrow transplantation. In conclusion, the antileukemic activity of the present IDA protocol is testified by the high CR rate and by the possibility of minimizing the role of prognostic factors. The better outcome of patients achieving CR after one induction course further supports the opinion that the intensity of the induction treatment, offered by an agent as potent as IDA, might significantly influence DFS.
57例既往未接受过治疗的成年急性髓系白血病患者接受了伊达比星（IDA）与阿糖胞苷序贯联合作为诱导治疗；缓解后治疗包括两个疗程的IDA和阿糖胞苷，与两个疗程的依托泊苷（VP-16）和阿糖胞苷交替使用。作为晚期强化治疗，患者接受了大剂量阿糖胞苷治疗，或10例患者接受了自体骨髓移植。48例患者（84.2%）实现了完全缓解（CR），其中41例在一个诱导疗程后实现缓解，7例在两个疗程后实现缓解。无病生存期（DFS）的中位数为26个月。单因素分析未发现任何研究变量在预测DFS方面具有预后意义。另一方面，在一个诱导疗程后实现CR的患者的DFS比需要两个疗程的患者更好。此外，DFS分析略微倾向于自体骨髓移植。总之，目前IDA方案的抗白血病活性通过高CR率以及将预后因素的作用降至最低的可能性得到了证实。在一个诱导疗程后实现CR的患者的更好预后进一步支持了这样一种观点，即由像IDA这样强效的药物提供的诱导治疗强度可能会显著影响DFS。
