Ghaddar H M, Pierce S, Kantarjian H M, Freireich E J, Keating M J, Estey E H
Department of Hematology, University of Texas M.D. Anderson Cancer Center, Houston 77030, USA.
Leuk Lymphoma. 1996 Jun;22(1-2):71-6. doi: 10.3109/10428199609051730.
The overall cure rate of adults with newly-diagnosed acute myelogenous leukemia (AML) treated with continuous infusion high-dose cytarabine (CIHDAC) is comparable to that with standard-dose ara-C plus anthracycline or amsacrine (AMSA). We tested whether the addition of AMSA to CIH-DAC improves the outcome of adults with untreated AML. 75 patients with untreated AML were treated with AMSA (75 mg/m2/day x 4) plus CIHDAC (1.5 g/m2/day x 4) for induction and, if in complete remission (CR), early and late intensification. Results were compared to those in 129 patients treated on a previous study with CIHDAC alone. The principal comparison in both groups was between those 117 patients (AMSA/CIHDAC n = 52, CIHDAC n = 65) who met the initial eligibility criteria for the AMSA/CIHDAC study (risk of early mortality < or = 1) and who were treated at a time when relatively few eligible patients were excluded (19% in the AMSA/CIHDAC group, 34% in the CIHDAC group). There was no difference between regimens in CR rate, remission duration, or survival in this cohort. When attention was turned to all 204 patients, outcome was superior with AMSA/CIHDAC very largely as a result of outcome in patients with APL. Aside from these patients, addition of amsacrine to CIHDAC did not appear to be productive.
接受持续输注大剂量阿糖胞苷（CIHDAC）治疗的新诊断急性髓性白血病（AML）成人患者的总体治愈率与接受标准剂量阿糖胞苷加蒽环类药物或安吖啶（AMSA）治疗的患者相当。我们测试了在CIH-DAC中添加AMSA是否能改善未经治疗的AML成人患者的治疗结果。75例未经治疗的AML患者接受AMSA（75mg/m²/天×4）加CIHDAC（1.5g/m²/天×4）进行诱导治疗，若达到完全缓解（CR），则进行早期和晚期强化治疗。将结果与之前一项仅用CIHDAC治疗的129例患者的结果进行比较。两组的主要比较对象是117例符合AMSA/CIHDAC研究初始入选标准（早期死亡风险≤1）且在排除合格患者较少时接受治疗的患者（AMSA/CIHDAC组为19%，CIHDAC组为34%）。该队列中不同治疗方案在CR率、缓解持续时间或生存率方面无差异。当关注所有204例患者时，AMSA/CIHDAC组的治疗结果更佳，这主要是由于急性早幼粒细胞白血病（APL）患者的治疗结果。除了这些患者外，在CIHDAC中添加安吖啶似乎并无效果。
