本文關(guān)鍵詞： 白血病 髓細(xì)胞性 急性 阿糖胞苷 鞏固治療 療效比較性研究　出處：《浙江大學(xué)》2016年碩士論文　論文類型：學(xué)位論文

【摘要】：目的：探討中大劑量阿糖胞苷鞏固治療細(xì)胞遺傳學(xué)中低危的年輕急性髓系白血病(60歲),不同單次劑量,不同總累積量及不同療程數(shù)對(duì)預(yù)后的影響及毒副作用。方法：收集2010年1月至2015年1月期間我院收治的經(jīng)“DA/IA3+7”等誘導(dǎo)方案治療,1-2個(gè)療程后達(dá)完全緩解的初發(fā)AML,篩選出年齡60歲,細(xì)胞遺傳學(xué)低中危,并采用1次及以上中大劑量阿糖胞苷強(qiáng)化鞏固化療的病例142例。對(duì)患者身高體重、確診時(shí)血象、外周血異常細(xì)胞百分比、染色體、骨髓原始細(xì)胞百分比、白血病微小殘留病灶等資料進(jìn)行回顧性分析研究,電話隨訪了解生存情況。根據(jù)患者阿糖胞苷單次劑量,總累積量,化療療程數(shù),對(duì)患者進(jìn)行分組,對(duì)2年的OS、RFS指標(biāo)進(jìn)行評(píng)估,并比較化療期間不良事件。結(jié)果：共納入142例AML患者(60歲=。(1)據(jù)單次劑量分組,IDAC-1組(1.0 g/m~2/q12h～1.5 g/m~2/q12h)17例, IDAC-2組(1.6 g/m~2/q12h～1.9 g/m~2/q12h)71例,HDAC組(2.0 g/m~2/q12h～3.0 g/m~2/ql2h)54例。HDAC組在OS上顯著優(yōu)于IDAC-1組(p=0.014),且IDAC-2組與IDAC-1組相比OS也有改善的趨勢(shì)(p=0.092)。不同單次劑量分組間RFS無統(tǒng)計(jì)學(xué)差異。COX多因素分析提示單次劑量是OS潛在的危險(xiǎn)因素(總P=0.078, IDAC-2 vs IDAC-1:HR 0.566, 95%CI 0.216-1.479, p=0.245; HDAC vs IDAC-1:HR 0.243,95%CI 0.071-0.832,p=0.009)。(2)據(jù)總累積量分組,低Ara-C累積組(12 g/m~2)30例,中Ara-C累積組(12g/m~2～36 g/m~2)105例患者,高Ara-C累積組(≥36 g/m~2)7例。中Ara-C累積組在OS上顯著優(yōu)于低Ara-C累積組(p=0.018),高Ara-C累積組與低Ara-C累積組相比,OS有改善的趨勢(shì)(p=0.076)。不同總累積量分組間RFS無統(tǒng)計(jì)學(xué)差異。COX多因素分析提示總累積量是OS潛在的危險(xiǎn)因素(總P=0.097,中累積量vs低累積量：HR 0.367,95%CI 0.148-0.911, p=0.031;高累積量vs低累積量：p=0.980)。(3)據(jù)療程數(shù)分組,1療程組43例,2療程組72例,3+4療程組27例。不同療程數(shù)間OS無統(tǒng)計(jì)學(xué)差異。3+4療程組在RFS上顯著優(yōu)于1療程組(p=0.035)及2療程組(p=0.037)。COX多因素分析提示療程數(shù)是RFS的潛在危險(xiǎn)因素(總P--0.121,1次vs 3+4次：HR 2.695,95%CI 0.747-9.719, p=0.130;2次vs 3+4次：HR 3.559,95% CI 1.052-12.045, p=0.041)。隨著Ara-C劑量及療程數(shù)增加,復(fù)發(fā)率有下降趨勢(shì),但觀察期內(nèi)各組間復(fù)發(fā)率,早期復(fù)發(fā)率,死亡率無顯著性差異。血液學(xué)不良反應(yīng)方面,4次化療間中性粒細(xì)胞缺乏時(shí)間無明顯差異(P=0.588),各分組間粒缺時(shí)間亦無明顯差異。結(jié)論：對(duì)于細(xì)胞遺傳學(xué)低中危的年輕初發(fā)急性髓細(xì)胞白血病患者(60歲),單次Ara-C化療劑量1.5 g/m~2/q12h,總Ara-C累積量12 g/m~2能改善患者的OS�；煰煶虜�(shù)≥3次,可改善患者RFS,并且不同劑量,不同療程數(shù)分組在主要的血液學(xué)不良反應(yīng)方面相似,患者可耐受3療程及以上的較大劑量的阿糖胞苷化療。
[Abstract]:Objective: to investigate the effect of medium and high dose cytarabine on the treatment of young acute myeloid leukemia with low and dangerous cytogenetics. Methods: from January 2010 to January 2015, the primary AMLs treated with "DA/IA3 7" and other induction regimens were collected to complete remission, and the age was 60 years. One hundred and forty two patients with moderate and high dose cytarabine reinforcement chemotherapy were enrolled in this study. The height and weight of the patients, the percentage of abnormal peripheral blood cells, the percentage of chromosomes, and the percentage of bone marrow primordial cells were measured. According to the single dose of cytosine arabinoside, the total cumulative dose, the number of chemotherapy courses, the patients were divided into groups to evaluate the 2-year OSN RFS index, according to the single dose of cytarabine, the total cumulative dose, the number of chemotherapy courses, and so on. The adverse events during chemotherapy were compared. Results: a total of 142 patients with AML were divided into two groups according to a single dose: 17 patients in the IDAC-1 group received 1.0 g / mt2q12hmnrm2g / mh, and 17 patients in the IDAC-2 group had 1.6gmmmmmmmm2rq12h 1.9 g / m2q12h 1.9 g / m2q12hwe, 71 patients in the HDAC group received 2.0 gmmmmmm2q2q2hnmnmmmmmmmr2ql2hmmmmmmmmr2ql2hmmmmmmmmr2ql2hm2hmmmmmmmr2ql2hm2gmmmmr2ql2hm2gmmmmr2ql2hdc, respectively. There was no significant difference in RFS between different single dose groups. Cox multivariate analysis showed that single dose was a potential risk factor for OS (total P0. 078, IDAC-2 vs IDAC-1:HR 0. 566, 95 CI 0. 216-1.479, p0. 245; HDAC vs IDAC-1:HR 0. 2439 CI 0. 2439 CI 0. 071-0. 832 CI 0. 009). In the low Ara-C accumulation group, 30 patients were diagnosed as 12g / mng, and in the middle Ara-C accumulation group, there were 236g / mng / mor 2105patients in the middle Ara-C accumulation group. The high Ara-C accumulation group (鈮，

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