Clinical Observation Of Mitoxantrone In Combination With Medium-dose Cytarabine Regimen In The Treatment Of Senile Patients With Acute Myeloid Leukemia

Objective: The proportion of elderly patients with acute myeloid leukemia(AML)in adule AML is higher than 50%,and with the aging trend incressing,the incidence rate of elderly aml patients is increasing year by year.But in elderly AML patients,because of the more basic diseases,poor physical condition,organ function decline,coinfection and severe bleeding,raical hematopoietic stem cell transplantation(HSCT)is limited.The traditional chemotherapy mode is reduced remission + maintenance therapy.In this study,We used Mitoxantrone in combination with medium-dose cytarabine(MA)as intensive treatment for elder AML pationts so as to analyze it’s clinical efficacy and the clinical outcomes of these patients.Method: Clinical data of 68 patients with AML in shenzhen people’s hospital from January 2009 to June 2015 was analyzed retrospectively.Patients were randomized into the experimental group and control group,after one or two durations of daunorubicin + cytarabine(DA regimen).In experimental group(n=36)reinforcement therapy with three durations of mitoxantrone + medium dose cytarabine(MA regimen)was applied,while in the control group(n=32)high dose of cytarabine was applied.Then the patients were followed up for 4 years for observing the recurrence-free survival and overall survival.The toxic and side effects during the intensive treatment of the two groups were also assessed.Single factor analysis and logistic regression analysis were used to evaluate prognostic factors of elder patients with AML.Result: Up to June,2019,the recurrence-free survival rates of the experimental group were 75.00%(27/36),66.67%(24/36)and 33.33%(12/36)in 1 year,2-year and 4-year,respectively.The overall survival rates of 1 year,2-year and 4-year were respectively 91.67%(33/36),77.78%(28/36)and 58.33%(19/39);In the control group,RFS was 61.11%(22 / 36),53.13%(17 / 32)and 28.13%(9 / 32)in 1 year,2-year and 4-year,respectively.The OS was 78.12%(25 / 32),59.37%(19 / 32)and 43.75%(14 / 32);Factors such as gender,age,white blood cell(WBC),bone marrow blasts and peripheral blood blasts,secondary AML,hypertension,diabetes,the number of induction courses and induction regimen were analyzed by survival analysis.The results showed that age,bone marrow blasts and peripheral blood blasts were significantly different between both groups(p<0.05).Other factors seemed to have no effects on prognosis of the patients(p>0.05).It was found by Logistic regression analysis that age,induction regimen,primary bone marrow cells,primary peripheral blood cells were factors influencing the prognosis of patients.Adverse events included gastrointestinal reaction,myelosuppression,bleeding,lung infection,liver dysfunction,and cardiac dysfunction,most of which could reach tolerance standard by transfusion,usage of G-CSF,and antibiotics therapy.Incidences of gastrointestinal reaction,myelosuppression,bleeding were lower in the first course intensive in experimental group(p<0.05),while differences of incidences of lung infection,liver dysfunction,and cardiac dysfunction were in-significant(p>0.05).In the secondary course of intensive therapy,incidences of gastrointestinal reaction,myelosuppression,bleeding,lung infection,liver dysfunction,and cardiac dysfunction were significantly lower in experimental group(p<0.05).In the third course of intensive therapy,one patient died because of severe toxic side effects,and one died of cerebral hemorrhage.There were three cases died in control group because of severe toxic side effects,two died of cerebral hemorrhage.The side effects such as gastrointestinal reaction,myelosuppression,hemorrhage,lung infection,liver dysfunction,and cardiac dysfunction in the experimental group were significantly lower than those in the control group(p<0.05).Conclusions: 1.In elder AML patients as a special group,DA+ MA regimen and DA+ high-dose cytarabine regimen showed efficacy.The recurrence-free survival rate of DA+ MA regimen were significantly higher than DA+ high-dose cytarabine regimen.2.Gastrointestinal reactions,myelosuppression,hemorrhage and other side effects were lower in DA+MA regimen than DA+ high-dose cytarabine.3.The total survival time of DA + MA is longer than that of DA + high dose cytarabine.