The Therapy Of Refractory And Relapsed AML

Part One The rapeutic effects of demethylation combined Intermediate-dose cytarabine regimen in the treatment of refractory and relapsed acute myeloid leukemiaObjective To observe the therapeuticefects of demethylation combined intermediate-dose cytarabine regimen in the treatment of refractory and relapsed acute myeloid leukemia and explore the new solutions of those patients in the clinical treatment.Methods 12 patients who were diagnosed as refractory and relapsed acute myeloid leukemia were selected from Jan.2014 to Oct. 2014, on the basis of agreement of patients and their family members and refer to relevant references, we designed the chemotherapy regimens of DAC+FLAG + HHT and evaluated the curative effect and security of the treatment.Results(1).The adverse reaction of chemotherapy was bone marrow suppression and secondary infection. 12 patients had occurred four degree of hematologic adverse reactions.10 patients with varying degrees of fever, including 6 cases were three to four infections. Pathogen detection discovers 1 case of stenotrophomonas maltophilia. Bacterium found in 2 cases of oral fungus. It clears lung infection in 5 cases, urinary tract infection in 2 cases and skin soft tissue infection in 1 case by imaging examination. The second gastrointestinal adverse reactions occurred in 3, three times in 1 case. All of the patients appeared different degree of skin mucous membrane petechiae, there was no three to four degree of bleeding or liver or kidney impairment etc. No phenomenon of death because of infection or bleeding.(2) Review of the bone marrow aspiration after peripheral blood image restoration, 10 patients received complete remission(CR), 2 patients were non-remission(NR).The effective rate was 83.3%.Flow cytometry detect the minimal residual disease of leukemia of 10 patients in CR, All of them were below the detection limit.(3)Follow-up the 10 patients of CR, 2 patients in complete remission(CR) move on hematopoietic stem cell, including 1 case of allogeneic hematopoietic stem cell transplantation, sustained remission 3 months before. And another case had haploid transplantation, which hematopoietic function had been reconstructed.6 cases go on regular chemotherapy after CR, and the partial matches have been found in the Chinese marrow donor program(CDMP), subsequent to stem cell transplantation.2 patients lost to follow-up because of economic reasons to give up treatment. For 2 patients of NR, there was one case died of intracranial hemorrhage in the process of chemotherapy, another case of primary resistance induced persist for many times, which was in palliative care still.Conclusions Demethylate combined chemotherapy regimens is a well-effective and relatively safe treatment regimen for patients with refractory or relapsed acute leukemia based on our small samples of data, it may be improve the long-term outcome of those patients by increasing sample of study. Part Two Curative effect of strengthening preconditioning regimen(IBU) for autologous hematopoietic stem cell transplantation in the treatment of acute myeloid leukemiaObjective Exploring the curative effect and security of preconditioning regimen which is high doses idarubicin combine busulphan(IBU) for autologous stem cell transplantation(AHSCT) in acute myeloid leukemia(AML), and all of them have poor clinical prognosis without donor.Methods Collect and analysis the data which failed to find an appropriate donor poor prognosis group of 10 patients with AML, schemes for the application of the preconditioning AHSCT in our department between April 2011 to March 2014.Observate hematopoietic reconstruction time after transplantation, transplantation related complications and follow-up.Results 10 patients were successfully obtained hematopoietic reconstruction. Follow-up time to March,2015, 9 patients were alive, median follow-up time was 20 months(10-38 months).Now 80% of patients are alive, and of which 70% still in CR. 3 cases of recurrence after transplantation, respectively in 3 months/5 months and 6 months.2 cases are still in treatment,1 case died of intracranial bleeding after recurrence. The accumulative total recurrence rate was about 30%.Conclusion IBU as preconditioning regimen for AHSCT in acute myeloid leukemia of poor clinical prognosis has good curative effect, besides the adverse reactions are controllable. Those poor prognosis of AML who did not find the suitable donor but required to take hematopoietic stem cell transplantation, it can be used as another alternative.