改良FLAG与HAA方案治疗复发难治性急性髓系白血病疗效的对比研究

Curative effects of modified FLAG and HAA on relapsed refractory acute myeloid leukemia

摘要:

目的  对比分析改良氟达拉滨联合阿糖胞苷和粒细胞集落刺激因子方案（FLAG）与高三尖杉酯碱、Ara-C和阿柔比星联合方案（HAA）对复发难治性急性髓系白血病（AML）的疗效及安全性。方法  回顾性分析29例复发难治性成年非M3型AML患者的临床资料，按化疗方案分为改良FLAG组（17例）和HAA组（12例），观察两组的疗效及不良反应。结果  改良FLAG组完全缓解（CR）10例（58.80%），部分缓解（PR）1例（5.88%），总有效率（■）为64.68%（11/17）。HAA组CR 6例（50.00%），PR 1例（8.33%）；■为58.33%（7/12）。两组有效率比较差异无统计学意义（P >0.05）。两组患者的主要不良反应为骨髓抑制、感染，改良FLAG组骨髓抑制作用较HAA组重，但两组在并发感染、出血、肝脏及心脏毒性等非血液学不良反应发生率方面比较，差异无统计学意义。结论  改良FLAG方案和HAA方案均为复发难治性AML的有效治疗方案，两者疗效相近，心脏毒性低，不良反应可耐受，可作为复发难治性AML的一线治疗方案。

Abstract:

Objective To investigate the efficacy and toxicity of modified FLAG and HAA on relapsed refractory acute myeloid leukemia (AML). Methods Retrospective analysis was used to observe the therapeutic effects and side effects of 29 cases of relapsed refractory adult AML, which were divided into modified FLAG group (17 cases) and HAA group (12 cases) according to chemotherapy regimens. Results In the modified FLAG group, the complete remission (CR) rate was 58.80% (10/17), the partial remission (PR) rate was 5.88% (1/17), the overall response (■) rate was 64.68% (11/17). In the HAA group, the CR rate was 50.00% (6/12), the PR rate was 8.33% (1/12), and the overall response ■ rate was 58.33% (7/12); there were no statistical differences between the two groups (P > 0.05). The main toxicities of the two groups were myelosupression and infection. Myelosupression in the modified FLAG group was severer than that in the HAA group. There was no significant difference in the incidence of secondary infection, haemorrhagia, hepatic toxicity or cardiac toxicities between both groups. Conclusions Both HAA regimen and modified FLAG regimen are effective for treatment of relapsed refractory adult acute myeloid leukemia with similar efficacy and low cardiac toxicity, and their side effects can be well tolerated. Thus, modified FLAG regimen and HAA regimen can be used as first-line treatment for this disease.