| background and objiective:Leukemia is a malignancy characterized by colonal proliferation of hematopoietic stem cells, leukemia cells for its self-renewl enhanced, reproducing out of control, differentiation obstacles,apoptosis thwarted, state at different developmental phases. In bone marrow and other tissues, leukemia cells hyperplasia of large accumulation, while the normal hematopoisis is inhibited and other tissues and organs are inflitrated.Through chemotherapy make leukemia patients quickly acquired complete remission, is induction chemotherapy, the first therapy stage and the base of the following treatment for leukemia. Early in 1995, K.Yamada etc firstly devise the priming regimen(low dose cytarabine and aclarubin in combination with granulocyte colony-stimulating factor),also known as CAG regimen for the treatment of patients with relapsed/refractory acute myeloid leukemia (AML) and previously untreated elderly patients with AML. The result of their study showed high total efficacy rate up to 81% and few hematological and non-hematological side effects.In recent years, the priming regimen has been recognized by everyone, as its great curative effects in treating acute myeloid leukemia. But it is limited only in treating those patients such as the older low proliferative AML, acute myeloid leukemia transformed from myelodysplastic syndrome or someone who with vital organs basic diseases could not tolerate standard chemotherapy. The objective of this study is to expand the applications of improved priming regimen in Induction therapy with marrow like hyperplasia active acute myeloid leukaemia and refractory acute lymphocyte leukemia and observe the curative effect and side effects.Method:6 patients with relapsed/refractory acute lymphocyte leukemia were treated by combination CAG regimen (aclarubicin hydrochloride, low-dose cytarabine and granulocyte colony-stimulating factor) with L-asparaginase and prednisone.11 patients with relapsed/refractory acute myeloid leukemia were treated by combination CAG regimen (aclarubicin hydrochloride, low-dose cytarabine and granulocyte colony-stimulating factor) with HHT (Homoharringtonine).observation their curative effects and adverse reactions.Result:After a course of induction therapy with the combination CAG regimen with L-asparaginase and prednisone, five patients achieved complete remission, one achieved partial remission, the total efficiency rate is 100%(6/6), the complete remission rate is 83.3%(5/6).the median time of those five patients who achieved complete remission is after recieving chemotherapy 14(9-21)days. The most common adverse effects are myelosuppression and fever, no cases died from complications during the treatment proccess. the median times of Leukocytes, hemoglobin, platelet reducing to the minimal appear respectively after beginning chemotherapy 13 (10-18) days,10 (8-14) days,6 (3-10) days. The lowest duration time lasts for respectively 8 (5-11) days,11 (9-13) days,13 (10-15) days. Three patients of the six appear fever, median duration time of 9 (5-13) days.one patient suffered severe pulmonary fungus infection, got to well after be given antifungal therapy, after empirical antimycobacterial treatment,others all came to normal. All of the patients presented with different degrees of gastrointestinal reaction, after recieving symptomatic treatment, get well as normal. Not only no acute or chronic pancreatitis occurs, but also no serious heart, kidney, liver disfunction apears.the 11 patients,treated with the regimen consisting of CAG and HHT, six achieved complete remission,3 partial remission,2 not remission, the complete remission rate is 54.5%,the overall efficiency rate is 81.8%. the median complete remission time is after recieving chemotherapy 14(9-21)days, The major adverse effects are myelosuppression,fever and Secondary infection, no death appear in the treatment process, the median times of Leukocytes, hemoglobin, platelet reducing to the minimal appear respectively after beginning chemotherapy 11 (7-17) days,10 (8-13) days,5 (11-21) days, The lowest duration time lasts for respectively 7 (5-13) days,11 (9-13) days,15 (10-15) days. The infection rate is 54.5%, most areⅠorⅡdegree. The mainly non-hematological side effects was gastrointestinal reaction such as nausea, vomit etc. No serious heart, liver or kidney function damage cases occurs.Conclusion:1.The regimen consisting of CAG, prednisone and L-asparaginase with considerable curative effect and few adverse effects,is an new regimen,worth exploring for refractory acute lymphocyte leukemia.2. The regimen consisting of CAG and HHT (Homoharringtonine) is an worth trying induction regimen for relapse/refractory acute lymphocyte leukemia because of its good curative effect and high security. |
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