A Comparative Study On Treatment Program Of VDLP And VDCLP In Acute Lymphocytic Leukemia

Objective：To compare the efficacy and toxicity between VDLP regimen（VDLP regimen）and VDCLP regimen（VDCLP regimen）in Adult patients withacute myeloid leukemia by retrospective analysis.Materials and Methods：44newly diagnose patients with ALL who werediagnosed between November2005and September2011were enrolled in our hospital.The diagnostic criteria is based on Internal diagnostic criteria. The44cases weredivided into groups with VDLP regimen and VDCLP regimen according to differentchemotherapy,23patients were given VDLP regimen and the other21were givenVDCLP regimen. According to different chemotherapy, we adopt two regimens tocompare the efficacy and toxicity. We compared measurement data with t text orrepeated measurement design、count data with x2text, and calculated overall survivaland progression-free survival with Life table method and Kaplan-Meier, P＜0.05hasstatistic significance.Results：1. There were23cases treated with VDLP regimen：the totallyeffective rate is95.65%, complete remission19（82.61%）, partial remission3（13.04%）, non-remission1例（4.35%）. There were21cases treated with VDCLPregimen：the totally effective rate is90.48%, complete remission17（80.95%）, partialremission6（15.29%）, non-remission1（4.76%）.The statistics analysis showsP=1.00and P=0.60, which means there was no significant differences in totallyeffective rate and complete remission rate between the two groups.2. After chemotherapy, in VDLP regimen the declining level of white bloodcells、red blood cells and platelets respectively is(24.25±92.21)%、(-8.53±38.33)%、(-221.78±374.24)%；in VDCLP regimen，the declining level of white blood cells、redblood cells and platelets respectively is（39.15±57.86）%、（-8.39±32.71）%、 （-141.87±306.74）%, and the statistical analysis, there was no significant differencesin the declining level of white blood cells、red blood cells and platelets between thetwo groups (P=0.38, P=0.64, P=0.45).3. After chemotherapy, in VDLP regimen，the lowest of WBC、Hb and PLTrespectively is（0.57±0.08）×109/L、（60.74±3.26）g/L、（39.91±10.10）×109/L;in VDLP regimen， the lowest of WBC、HB and PLT respectively is（0.68±0.14）×109/L、（61.62±3.97）g/L、（44.62±10.83）×109/L, and the statistical analysis, therewas no significant differences in the lowest of WBC、HB and PLT between the twogroups (P=0.40, P=0.85, P=0.38).4. In peripheral blood neutrophils lack of (<0.5x109/L) time，VDLP regimenand VDCLP regimen Need respectively（9.3±0.12）days、（11.2±0.86）days, thestatistics analysis shows P=0.13, so there was no significant difference between them.In the duration of the lack of peripheral blood neutrophils，VDLP regimen andVDCLP regimen Need respectively（10.48±0.75）days、（11.0±0.75）days, the statisticsanalysis shows P=0.65, so there was no significant difference between them. In thebone marrow recovery time，VDLP regimen and VDCLP regimen Need respectively（9.4±0.48）days、（10.3±0.39）days, the statistics analysis shows P=0.58, so therewas no significant difference between them the two groups.5. VDLP regimen infused red blood cells and platelets in the number of units, isrespectively（20.26±6.72）u、（20.04±9.75）u；VDCLP regimen infused red blood cellsand platelets in the number of units, is respectively（19.23±6.04）u、（18.57±6.58）u；by the statistics analysis, there was no significant difference between the two groups（P=0.64、P=0.73）.6. In the course of chemotherapy, there was a significant difference of incidencerate of hair loss between VDLP regimen5（21.74%）and VDCLP regimen11(52.38%),there was a significant difference between the two groups（P=0.04）; between VDLPregimen6(26.09%)and VDCLP regimen VDCLP regimen12(57.14%), there was asignificant difference between the two group（sP=0.04）;But there were not significantdifferences of incidence rate of renal toxicity、cardiac toxicity、muscle soreness、 liver toxicity、gastrointestinal reaction between the two groups（P=0.66、P=0.60、P=0.47、P=0.63、P=0.39）.7. To study termination, with a median follow-up of14.5months（1～46months）, all patients with a median OS was17.5month（s1～51months）. Up to CR15patients were followed up PFS, median PFS was13month（s1～48months）.VDLPregimen Median OS was12months（0～49months）,with a median PFS was13months（1～48month）,of which5patients still no progression-free survival, and therelapse rate was37.50%（2/8）at9～25months,; VDCLP regiment median OS was11months （0～48months）, median PFS12months（3～49months）, of which5patients still no progression-free survival, the relapse rate was28.6%（2/7）in10～23months,6case still under treatment, the remaining1patients have died. The relapserate of the two groups have not a significant difference by comparing their relapse（P=0.71）.8. In the44cases,30cases were tested with chromosome karyotyping, in whichthe CR rate of Standard risk chromosome karyotyping group was87.50%, nosignificantly difference than the high-risk group of CR rate of78.57%（P=0.64）。The3years PFS（50%）of Standard risk chromosome karyotyping group was longer thanthe high-risk group（7.14%）, there was a significant difference between the twogroups（P=0.00）.Conclusion：1. ALL-L2was the most common subtype of the ALL；B-ALL wasthe most common Immune phenotype of ALL.2. The karyotype of abnormal chromosomes will affect survival situation, bydetecting karyotype can evaluate the prognosis of patients.3. In the therapy of previously untreated elderly patients with ALL, VDLPregimen was to be as effective as VDCLP regimen in totally effective rate andcomplete remission rate, but its intensity of chemotherapy is soft, mucositis and hairloss rate lower than the latter，VDLP regimen can serve as effective chemotherapy inadult first treatment for ALL.