| Background:Leukemia is a malignant clonal hematopoietic stem cell disorders, clonal proliferation of leukemic cells because of uncontrolled differentiation disorders, blocked apoptosis mechanisms proliferate accumulate in the bone marrow and other hematopoietic tissues and infiltration of other tissues and organs, and inhibition of normal hematopoiesis. Acute myeloid leukemia(acute myelocytic leukemia, AML) including acute non-lymphocytic leukemia all sources. Acute myeloid leukemia is a clonal myeloid progenitor cells and malignant proliferative diseases of the hematopoietic system. It is a highly heterogeneous group of disorders, which may consist of normal myeloid cells at different stages during the development of malignant transformation of hematopoietic progenitor cell transformation. Leukemia belongs to malignant tumor of the blood system, whose main treatment is chemical treatment. However, considering side effects of chemical treatment, it exists limitations. Studying the effect and adverse reactions of chemotherapeutic drugs is great significance for guidance. In this article, we will study the curative effect of anthracycline-based drugs and their side effects, expecting to play a guiding role of comprehensive treatment of the tumor.Objectives:The objective is to investigate IA protocol on the efficacy and side effects in patients with acute myeloid leukemia.Methods:Our hospital in June 2009 to July 2013 were treated 177 cases of denovo acute myeloid leukemia in patients with clinical data, all patients were admitted to hospital after routine care treatment, patients in the observation group to methoxy soft red ADM(IDA)(8.0-10.0) mg/m2/d, dissolved in 100 ml of 0.9% Na Cl solution for intravenous infusion,d1-d3; cytarabine 100.0mg/m2/d, twice a day, intravenous infusion, infusion time more than 4 hours each time, continuous infusion 7d; control group patients were soft red mold Su(DNR)(40.0-45.0) mg/m2/d, intravenous infusion,d1-d3; cytarabine 100.0mg/m2/d, twice a day, intravenous infusion, each infusion of more than 4 hours of continuous infusion 7d. Clinical efficacy, relapse and side effects of the two groups was compared.Results:(1) Treatment efficacy: 1) 116 patients in the observation group, 4 patients died early( three cases of intracranial hemorrhage, 1 case of fulminate hepatic failure), a course of CR 75 cases, PR15 example, NR 22 cases, the CR rate(1CCR) was 66.96%( 75 / 112), two courses CR 16 cases, PR 5 cases, NR 16 cases, the CR rate(2CCR) was 81.25%( 91 /112).61 patients in the control group, the early death of four cases( intracranial hemorrhage), a course of CR 23 cases, PR16 cases, NR18 cases, the CR rate was 40.35%( 23 / 57), 2 courses CR7 example, PR 10 cases, NR 17 cases, the CR rate was 52.63%( 30/ 57). 2) to alleviate the situation : the observation of 1CRR and 2CRR in studing group and control group was 66.96% to 40.35% and 52.63% to 81.25% respectively. There is statistically significant difference between two groups(P <0.05). 3) Except the early deaths,the numbers of cases whose age were less than 60 years in the observation and control group were 100 and 52 respectively. At the same time, their CR rate were 84.00% and 50%. However, the number of cases whose age were more than 60 years in the study and control group were 12 and 5 respectively. What’s more, their CR rate were 58.33 %and 80.00%. The differences between the groups was statistically significant(P <0.05).(2) recurrence 1)relapse-free survival: to observe the group of patients with a median time to relapse-free survival(9.7 ± 1.6) months, significantly longer than the control group, the median time to relapse-free survival(7.6 ± 1.0) months, with a significant difference between the groups was statistically significant(P <0.05). 2) recurrence rate : observation group 91 cases of CR patients, 21 cases of recurrence, the recurrence rate of 23.08%; the control group of 30 patients in CR patients, 15 cases of recurrence, the recurrence rate of 50.00%. There was statistically significant in the two groups(χ2 = 4.977, P < 0.05).(3) Evaluate the toxicity 1) Hematologic toxicity: two groups of patients after chemotherapy side effects are the main hematologic toxicity; there were grade IV myelosuppression. Study group : 98 % of patients after treatment appears neutropenia, neutropenic lowest median 0.03(0-0.4 × 109 / L), neutropenic median occurrence 6(1-12) d, the median neutropenic duration 21(3-45) d; 88.9% of patients platelets <20 × 109 / L, the median lowest platelet 12(1-20) × 109 / L, the median platelet recovery time 31(22-42) d. Control group : 97 % of patients after chemotherapy appears neutropenia, neutropenic lowest median 0.04(0-0.5) × 109 / L, the median occurrence of neutropenic 5(1-10) d, the median neutropenic duration of 19(2-40) d; 80.1% in patients with platelets <20 × 109 / L, the median lowest platelet 10(1-19) × 109 / L, the median platelet recovery time of 33(24-40) d. 2) non-hematologic toxicity: After chemotherapy, patients were non-hematologic toxicity mainly in gastrointestinal toxicity, cardiac toxicity, liver toxicity, kidney toxicity, allergies, neurotoxicity, and mucosal inflammation, which, observation group occurred in patients with cardiac toxicity, liver toxicity, kidney toxicity was significantly lower than the control group of patients, differences between groups were statistically significant( P <0.05).Conclusion:1) IA program( idarubicin + Ara-C) 1 and 2 courses of treatment were significantly higher CRR.( P <0.05). 2) The patients with IA program was significantly longer median time to recurrence than DA chemotherapy( P <0.05).. 3) The recurrence rate IA program is significantly lower than DA chemotherapy( P <0.05). 4) non- hematologic toxicity in IA programs, such as cardiac toxicity, liver toxicity, kidney toxicity was significantly lower than the control group( P <0.05). Overall, compared with the observation group program for acute myeloid leukemia with the control group program, has a more significant response rate, effective than the control group program, at the same time, lower non- hematologic toxicity IA program having a high safety. Because the prognosis cytogenetics acute myeloid leukemia has a very important role, so it should be conducted in patients with newly diagnosed diagnosis assessment of chromosome karyotype, and strive to complete remission as early as possible, thus improving the quality of life. |
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