老年急性非淋巴細(xì)胞白血病23例臨床分析

蘭曉曦++++++孫婉玲++++++惠吳函++++++趙弘

[摘要] 目的 探討老年急性非淋巴細(xì)胞白血病的臨床特征及合理治療方案。 方法 回顧性分析2012年7月～2015年6月首都醫(yī)科大學(xué)宣武醫(yī)院血液科23例老年急性非淋巴細(xì)胞白血病患者的臨床資料，按個(gè)體情況及治療意愿分為姑息治療組（5例）、去甲氧柔紅霉素聯(lián)合阿糖胞苷標(biāo)準(zhǔn)誘導(dǎo)化療方案（IDA方案）組（5例）、低劑量阿糖胞苷和阿克拉霉素聯(lián)合粒細(xì)胞集落刺激因子誘導(dǎo)化療方案（CAG預(yù)激方案）組（9例）和小劑量化療方案組（4例），對(duì)其生存率及不同治療組的療效進(jìn)行比較。 結(jié)果 23例患者中位生存時(shí)間為10個(gè)月，姑息治療組為0.75個(gè)月，接受化療組為16個(gè)月。接受化療組完全緩解率達(dá)66.7%，總生存率顯著高于姑息治療組（P < 0.01）。IDA方案組及CAG預(yù)激方案組總生存率明顯高于小劑量化療組患者（P=0.021）。 結(jié)論 IDA方案與CAG預(yù)激化療對(duì)于老年急性非淋巴細(xì)胞白血病患者有較好的治療效果。

[關(guān)鍵詞] 老年；急性非淋巴細(xì)胞白血病；完全緩解率；生存期

[中圖分類號(hào)] R733.71 [文獻(xiàn)標(biāo)識(shí)碼] A [文章編號(hào)] 1674-4721（2016）09（a）-0068-04

[Abstract] Objective To investigate the clinical characteristics and reasonable treatment of acute non-lymphocytic leukemia in elderly patients. Methods The efficacy and overall survival of 23 patients who were newly diagnosed acute myelocytic leukemia in Department of Hematology， Xuanwu Hospital， Capital Medical University from July 2012 to June 2015 and were treated with palliative care （n=5）， standard-dose idarubicin combined with cytarabine （IDA） regimen （n=5）， combination of low-dose cytarabine， aclarubicin and granulocyte colony-stimulating factor priming （CAG） regimen （n=9）， or reduced-dose chemotherapy （n=4）， according to the individual condition and the will were analyzed retrospectively. Results The median survival time of 23 patients was 10 months. The median survival time in the group of receiving palliative care and the group of receiving chemotherapy were 0.75 month and 16 months， respectively. The complete remission rate in the group of receiving chemotherapy was 66.7%. Overall survival rate in the the group of receiving chemotherapy was significantly higher compared to which in the group of receiving palliative care （P < 0.01）. The overall survival in the group of receiving CAG regimen and receiving IDA regimen was significant higher compared which in the group of receiving reduced-dose chemotherapy （P=0.021）. Conclusion IDA regimen and CAG regimen has better clinical efficacy for elderly patients with acute non-lymphocytic leukemia.

[Key words] Elderly patients； Acute non-lymphocytic leukemia； Complete remission rate； Overall survival

大約65%的急性非淋巴細(xì)胞白血病（AML）患者在診斷時(shí)年齡大于60歲[1]，其診斷中位年齡大約為70歲，而且?guī)缀?/3新診斷的AML患者超過75歲[2]，在這些患者年齡組，該疾病對(duì)治療反應(yīng)較差，在標(biāo)準(zhǔn)誘導(dǎo)化療后的第1個(gè)月內(nèi)，其死亡率約為15%，預(yù)期中位生存不超過1年[3]。國(guó)內(nèi)成人AML（非急性早幼粒細(xì)胞白血病）診療指南（2011年版）建議60～75歲臨床一般情況較好患者行標(biāo)準(zhǔn)劑量誘導(dǎo)化療或聯(lián)合粒細(xì)胞刺激因子的小劑量誘導(dǎo)化療，年齡大于75歲患者建議行聯(lián)合粒細(xì)胞刺激因子的小劑量誘導(dǎo)化療或支持治療。隨著科技和文明的進(jìn)步、全民醫(yī)療保險(xiǎn)逐步的實(shí)現(xiàn)，我國(guó)社會(huì)人口老齡化日益明顯，因此對(duì)于老年急性白血病患者的治療意義重大。本研究回顧性分析了2012年7月～2015年6月首都醫(yī)科大學(xué)宣武醫(yī)院（以下簡(jiǎn)稱“我院”）血液科收治的病歷完整的23例初治老年AML（非急性早幼粒細(xì)胞白血病）患者臨床資料。現(xiàn)報(bào)道如下：