Deliliers G L, Annaloro C, Oriani A, Della Volpe A, Boschetti C, Cortelezzi A, Maiolo A T
Cattedra di Medicina Interna, Ospedale Maggiore IRCCS e Università degli Studi di Milano.
Ann Ital Med Int. 1998 Jul-Sep;13(3):146-51.
Sixty-three non randomized adults with acute myelogenous leukemia were treated with an idarubicin-based protocol. The patients achieving complete remission received autologous bone marrow transplantation or (if > 50 years or refusing autologous bone marrow transplantation) high-dose Ara-C, as late intensification. Fifty-two patients (82.5%) achieved complete remission, 45 after one induction course and 16 of them underwent autologous bone marrow transplantation a median of 11 months later. As of December 1997 (median follow-up 112 months, range 50-135 months), 16 patients were still in complete remission (10 after autologous bone marrow transplantation, 6 after high-dose Ara-C) and 29 had relapsed (median time to relapse 14 months, range 2-75 months). Four patients died in complete remission. The median disease-free survival was 25 months; the 50-months and 10-year disease-free survival were 41% and 35% respectively. No significant differences were observed between the autologous bone marrow transplantation and high-dose Ara-C treated patients whose complete remission had lasted more than 11 months. The median disease-free survival in the autografted patients had not been reached after 120 months (the 50-month and 10-year disease-free survival chances were both 67%). Age was the only predictive variable for leukemic relapse. These long-term results confirm the antileukemic efficacy of an idarubicin-containing protocol, which led to high complete remission rates and favorably influenced disease-free survival. Furthermore, the efficacy of late intensification treatment with either autologous bone marrow transplantation or high-dose Ara-C is underscored. The disease-free survival chances after autologous bone marrow transplantation are comparable with those published for allogeneic bone marrow transplantation; however, disease-free survival of the patients receiving a high-dose Ara-C intensification regimen is not significantly worse than that seen after autologous bone marrow transplantation.
63例非随机分组的急性髓性白血病成人患者接受了以伊达比星为基础的方案治疗。达到完全缓解的患者接受自体骨髓移植或（年龄>50岁或拒绝自体骨髓移植者）大剂量阿糖胞苷作为晚期强化治疗。52例患者（82.5%）达到完全缓解，45例在一个诱导疗程后缓解，其中16例在中位时间11个月后接受了自体骨髓移植。截至1997年12月（中位随访112个月，范围50 - 135个月），16例患者仍处于完全缓解状态（10例自体骨髓移植后，6例大剂量阿糖胞苷治疗后），29例复发（中位复发时间14个月，范围2 - 75个月）。4例患者在完全缓解期死亡。无病生存期的中位数为25个月；50个月和10年的无病生存率分别为41%和35%。在完全缓解持续超过11个月的自体骨髓移植和大剂量阿糖胞苷治疗的患者之间未观察到显著差异。自体移植患者120个月后无病生存期的中位数尚未达到（50个月和10年的无病生存机会均为67%）。年龄是白血病复发的唯一预测变量。这些长期结果证实了含伊达比星方案的抗白血病疗效，该方案导致高完全缓解率并对无病生存期产生有利影响。此外，强调了自体骨髓移植或大剂量阿糖胞苷晚期强化治疗的疗效。自体骨髓移植后的无病生存机会与同种异体骨髓移植报道的相当；然而，接受大剂量阿糖胞苷强化方案患者的无病生存期并不比自体骨髓移植后显著更差。
