Clinical Analysis Of Induction Chemotherapy In Elderly Patients With Acute Myeloid Leukemia

Objective:To explore the efficacy and prognosis of combined induction chemother apy in elderly patients with acute myeloid leukemia.Methods: Clinical data of 40 cases of elderly AML patients from Jan 2000 to Apr 2015 were retrospectively analyzed. Including 2 M1, 21 M2, 6 M4, 3M5,3 M6,3 unknow,2 second AML. 26 cases received induction chemotherap y,among them 14 cases received Daunorubici +Cytarabine, 4 cases received M itoxantrone+Cytarabine,8 cases received aclacinomycin+Cytarabine+granulocyte.14 cases received palliative treatment, including subcutaneous injection of lowdose cytarabine 10-20 mg/(m2.d), hydroxycarbamide, anti-infection, compositio n blood transfusion. If complete remission(CR) or partial remission(PR) was achieved after 1-2 courses of induction chemotherapy, given the original sche me or other schemes to consolidate.To compare the efficacy and prognosis b etween induction chemotherapy group and palliative treatment group.Results: In induction chemotherapy group, CR rate was 46.1%,PR rate was 15.4% and overall response rate(OR) was 61.5%,1 case occurred early death(3.8%). 14 cases of DA,6 cases received CR,CR rate was 42.8%. 4 cases of MA,2 cases received CR,CR rate was 50%. 8 cases of CAG, 4 cases received CR,CR rate was 50%. There was no statistically significant difference in CR rate a mong the three groups(P=1.00). The rate of relapse was 54.5%, CR rate in re-i nduction was 16.7%. There were 7 case reach CR after 1 cycle treatment,5 cas e reach CR after 2 cycle treatment. In palliative care group,none of 14 patients achieved CR,2 cases occurred early death(14.2%).The reasons for early deaths were severe pulmonary infection, bleeding, respiratory and circulatory failure in t wo groups.Age over 70,CR rate was 27.3%,the rate of early death was 9.1%. U nder the age of 70,CR rate was 60%,the rate of early death was 0%.There was no one case receiving CR in patients with WBC≥100×109/L.The median survival time was only 1 month.The CR rate of patients with ECOG score < 2 and ≥2was 45% and 12%.1 case of WT1+ received CR,1 case FLT3-ITD+ received CR..2 case of better prognosis,1 case received CR,1 case did not receive remis sion.3 case of medium prognosis,1 case received CR,2 case did not receive rem ission.5 case of poor prognosis,1 case received CR,2 case received PR,2 case di d not receive remission.The median survival time in chemotherapy group was 6.0 months, while it was 2.5 months in palliative care group.The 1 years survival rate of patients was 19.2% and 70%,the 2 years survival rate of patients was 15.4% and 0%,the median survival time of chemotherapy group was longer than tha t of palliative treatment group(p=0.024).The advise events of induction chemother apy included myelosuppression,pulmonary infection,bleeding,gastrointestion and liv er dysfunction,but most of them could be tolerated after relative treatments,4 case s died of serious complications. The incidence of myelosuppression, bleeding and gastrointestinal reaction was higher in chemotherapy group than the palliative car e group, and the difference was statistically significant(P < 0.05).Conclusions: Induction chemotherapy can improve the prognosis of partial elderly patients with AML,and prolong their median survival time.