Advani S H, Hegde U P, Iyer R S, Gopal R, Saikia T K, Pai S K, Nair C N, Kurkure P A, Pai V R, Nadkarni K S
Department of Medical Oncology, Tata Memorial Hospital, Bombay.
Indian J Med Res. 1993 Feb;98:8-14.
Fifty three newly diagnosed patients of de novo acute myelogenous leukaemia (AML) received treatment consisting of remission induction with daunorubicin 60 mg/m2 on day one and continuous infusion of cytosine arabinoside 200 mg/m2/day over 24 h from day one to 7. Thereafter patients in complete remission received consolidation chemotherapy with two identical courses. Complete remission (CR) could be achieved in 40 patients (75.5%). Seven patients (13.2%) died with complications during aplasia phase following remission induction therapy while six patients (11.3%) had resistant disease. Twenty seven patients (67.5%) developed relapse while eight patients (15.1%) continue to remain in complete remission ranging from 51 to 68 months (median 62.5). The projected event free survival and disease free survival at 60 months is 15 per cent (SE + 11.9%) and 21 per cent (+6%) respectively. Evaluation of the prognostic significance of pretherapy characteristics showed that infection at presentation and low number of myeloperoxidase (MPO) containing blasts affected the achievement of complete remission adversely on univariate analysis. Similarly age at diagnosis, of more than 45 yr, total leucocyte count of 50,000/cumm or more and low number of MPO containing blasts affected the remission duration (disease free survival) adversely on univariate analysis. On multivariate analysis, MPO positivity of blast cells, remained the only significant independent characteristic. High MPO positivity affected the remission duration favourably (P < 0.01). Patients with high MPO positivity also achieved CR with one induction cycle in 32 out of 40 instances while only 2 out of 5 patients with low MPO positivity, achieved CR with one chemotherapy cycle (P < 0.01).(ABSTRACT TRUNCATED AT 250 WORDS)
53例初诊的急性髓系白血病（AML）患者接受了如下治疗：第1天给予柔红霉素60mg/m²进行缓解诱导，从第1天至第7天持续24小时静脉滴注阿糖胞苷200mg/m²/天。此后，完全缓解的患者接受两个相同疗程的巩固化疗。40例患者（75.5%）可实现完全缓解（CR）。7例患者（13.2%）在缓解诱导治疗后的再生障碍期因并发症死亡，6例患者（11.3%）疾病耐药。27例患者（67.5%）复发，8例患者（15.1%）持续完全缓解，缓解时间为51至68个月（中位时间62.5个月）。预计60个月时的无事件生存率和无病生存率分别为15%（标准误+11.9%）和21%（+6%）。对治疗前特征的预后意义评估显示，单因素分析时，就诊时感染和含髓过氧化物酶（MPO）的原始细胞数量低对完全缓解的实现产生不利影响。同样，单因素分析时，诊断时年龄超过45岁、总白细胞计数50,000/立方毫米或更高以及含MPO的原始细胞数量低对缓解持续时间（无病生存率）产生不利影响。多因素分析时，原始细胞的MPO阳性仍然是唯一显著的独立特征。高MPO阳性对缓解持续时间有有利影响（P<0.01）。40例中有32例高MPO阳性的患者通过一个诱导周期实现CR，而5例低MPO阳性的患者中只有2例通过一个化疗周期实现CR（P<0.01）。（摘要截选至250字）
