| Background:Acute myeloid leukemia(AML) is a highly heterogeneous bone marrow hematopoietic system abnormal proliferation of hematological malignancies. Its main characteristic is that a large number of myeloid progenitor cells and immature cells proliferation and extensive destruction or extramedullary organ infiltration, incidence of dangerous with a very poor prognosis.At present, it is widely used clinical treatment of acute myeloid leukemia is classic anthracene ring "3 + 7" drugs and cytarabine combined induction regimen,with a large number of new drug research and development, gradual optimization of treatment, chemotherapy also supplemented with blood components, a wide range of antibiotic use symptomatic support treatment, the curative effect of patients with AML were improved obviously. Domestic and foreign research shows, patients complete remission(CR) rate can reach 65%-85%. Genetics, immunology, initial white blood cell count and age of the prognosis related factors of AML treatment stratification provides the guidance of treatment. At this stage, induced treatment of acute myeloid leukemia two anthracycline drugs, to the idarubicin and daunorubicin,both has been widely used in clinical, but the at home and abroad of the two schemes differences in the efficacy of no definite conclusion.Objective:The research review of observation and analysis to idarubicin(IDA) and daunorubicin(DNR) combined with cytarabine chemotherapy at the beginning of the adult treatment acute myeloid leukemia clinical efficacy and adverse reactions.Method:Methods a retrospective analysis From June 1, 2010 to March 30, 2015, 147 cases of clinical data of Nanchang University First Affiliated Hospital hematology clinic of acute myeloid leukemia patients, diagnostic standard consults 2011 China adult acute myeloid leukemia(non acute promyelocytic myeloid leukemia) guidelines for diagnosis and treatment.A total of 147 patients were enrolled. In 63 patients given ia regimen(to methoxy daunorubicin(8-10) mg/m2/d, cytosine arabinoside(100-200) mg/m2/d,d1-7); 58 cases give DA(daunorubicin(40-45) mg/m2/d; cytarabine dose with IA regimen)- induced remission and contrast analysis of the clinical curative effect of two groups of patients, adverse reactions. In addition, 15 patients given IAE program(to idarubicin and cytarabine dose with IA regimen; etoposide(VP-16) 100mg/m2/d)." Finally, there were 11 cases underwent ia regimen after induction chemotherapy marrow checks as not complete remission, immediately single with cytosine arabinoside(Ara-C(100-200) mg/m2/d, d1-3/5) or CAG regimen(aclacinomycin100mg/m2/d cytarabine 10mg/m2/d, q12 h hypodermic injection, d1-14. Granulocyte set colony stimulating factor(G-CSF) 200 ug/m2/d, d1-14. Subcutaneous injection)additional chemotherapy.For high white blood cells of patients before induction chemotherapy and were treated with hydroxyurea to reduce load of white blood cells, to prevent uric acid induced acute renal damage and tumor lysis syndrome, chemotherapy, given hydration and alkalization treatment.Results:IA, Da group 1 course of complete remission rate, 66.7%(twenty- two) and48.2%(28/58), between the two groups comparison suggests ia group was better than that of Da group(P = 0.041). The risk of cytogenetic risk stratification in the high-risk prognosis group was less than two groups, it is difficult to carry out statistical analysis. In the middle risk group, the CR rate and total effective rate of the IA group were better than that of the DA group, and the difference between the two groups was obvious(<0.05 P). In the good prognosis group, the CR rate and total effective rate of the IA group were slightly better than that of the DA group, but there were no differences between the two groups. In the high WBC group, the IA regimen was better than the DA group, and the difference between the two groups was significantly(=0.023 P). There was no significant difference between the two groups in the non high leukocyte group. In the treatment of patients with AML M5, IAE scheme compared ia regimen, complete remission rate is slightly higher, but two groups of patients between groups no obvious difference compared(P = 0.394), two groups ofpatients the total efficiency of no significant difference. Additional regimen and IA scheme comparison, the former complete remission rate is slightly higher, but the difference between the two groups no significant difference(P = 0.962), two groups of cases total efficiency and also no significant differences.The main toxic and side effects of the two groups were bone marrow suppression, infection, nausea and vomiting, etc.Conclusion:1. IA regimen has better clinical effect than DA.2. IA scheme is compared to the DAscheme, in intermediate prognostic group and early treatment of high white blood cell group has better curative effect. The former is currently the best inducing remission scheme one.3. IAE regimen and IA regimen, in the treatment of patients with M5 AML have better effect.4. IN IA regimen induction chemotherapy remission, cytarabine or CAG regimen with additional chemotherapy can improve the patients with complete remission rate.5. Two groups of chemotherapy during chemotherapy and support for chemotherapy are important. |
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