The Study On IA And DA Regimens For Remission Induction Treatment Of Aged Acute Myeloid Leukemia

Objective：Elderly patients with acute myeloid leukemia (AML) is a common type of agedleukemia,but is difficult to treat and with poor outcomes,which has become one of thefocus of internaional and domestic research in hematological system diseases atpresent.In recent years, successions have been reported that complete remission (CR)rate with idarubicin and cytarabine (IA) regimen to induce adult AML has beensignificantly improvement than traditional standard daunorubicin and cytarabine (DA)regimen. However, the therapeutic effect in elderly AML patients is to be assessed.The objective of this study is to explore the clinical effects and toxicities of IA andDA regimens in the treatment of elderly patients with AML, which may make for thechoice of clinical treatment.Methods:Use retrospective analysis to observe the therapeutic effects and adverse reactionsof the60cases of aged patients with acute myeloid leukemia (AML-M3excepted)from January,2010to january,2014in the first Affiliated Hospital of Zhengzhou University. IA regimen group included22patients (8male and14females withmedian age of66years),while DA regimen group included38patients (20male and18females with median age of64years).IA regimen: Idarubicin (IDA)8mg/m2every day, intravenous drip,1～3d;Cytarabine (Ara-C)100mg/m2every day, intravenous drip,1～7d.DA regimen: daunorubicin (DNR)40mg/m2, every day, intravenous drip,1～3d;Cytarabine (Ara-C)100mg/m2every day, intravenous drip,1～7d.The complete remission rates, total effective rates and adverse effects after onehemotherapy course were observed and for statistical analysis.Results:IA regimen group:14cases achieved complete remission (CR), no cases achievedpartial remission (PR),CR rate was63.64%(14/22). DA regimen group:12casesachieved CR,2cases achieved PR, CR rate was31.58%(12/38). The statisticaldifference between the two groups is significant when compared(χ2=5.831,P=0.016).The total effective rate of IA group was63.63%(14/22);the total effective rate ofDA group was36.84%(14/38).The statistical difference between them was significanttoo(χ2=4.019,P=0.045).Adverse reactions of chemotherapy were mainly divided into two groups ofhematologic toxicity and non-hematologic toxicity.Hematologic adverse reaction was mainly myelosuppression:Both groupsexperienced Ⅲ degreeand above of bone marrow suppression,and were treated withvarying degrees of transfusion of red blood cells and platelets to improve symptoms.IA group:The average time of neutrophils less than1.0×109/L was15.29±3.91dsince the end of course of treatment;the average time of peripheral blood hemoglobinless than80g/L was13.43±6.77d since the end of course of treatment; and theduration of platelet less than50×109/L lasted9.86±4.09d since the end of course oftreatment.DA group: The average time of neutrophils less than1.0×109/L was14.63±5.44dsince the end of course of treatment;the average time of peripheral blood hemoglobinless than80g/L was12.86±5.07d since the end of course of treatment; and the average duration of platelet less than50×109/L lasted9.88±5.23d since the end ofcourse of treatment.Hematologic toxicities were similar on two regimens and there were nostatistically significant differences between the two groups(P>0.05).Non-hematologic adverse reactions: Secondary infection: IA group:18(81.82%)patients with varying degrees of infection, including6cases of pulmonaryradiographic evidence of infection,4cases of oral Candida infections,two cases ofskin and soft tissue infection,2cases with bacteremia,10cases of fever of unknownorigin,2patients with diarrhea;DA group:30(78.95%) patients with varying degreesof infection, including18cases of infection who have pulmonary radiographicevidence,2cases of oral Candida infections,12cases of fever of unknown origin,2cases of urinary infection,6patients with diarrhea. The incidences of secondaryinfection on two regimens were similar(P>0.05). Other adverse reactions includedgastrointestinal reactions such as nausea and vomiting,oral ulcers, skin and mucousmembrane bleeding, bruising, blood stained sputum, gingival bleeding, epistaxis, hairloss, liver and kidney toxicity, cardicac toxicity,and so on. With the exception of thatthe difference of the incidence of oral ulcers (45.45%&10.53%)was statisticallysignificant(χ2=9.502,P=0.002), the difference of incidences among the otheradverse reactions were not statistically significant(P>0.05).Conclusions:For elder AML patients, IA regimen can achieve a higher CR rate and totaleffective rate than DA regimen without increasing adverse effects after one inductionchemotherapy course.