| Objectives:This study investigated the therapeutic effect and related prognostic factors of 60 years old>patients with acute myeloid leukemia(non-m3),in order to better guide the selection of clinical treatment options for elderly AML patients.Methods:The clinical data of AML(non-m3)patients aged 60 years or older who were admitted to the hematology department of the second affiliated hospital of kunming medical university from January 2014 to January 2017 were retrospectively analyzed.A total of 39 patients completed 1 course of induced remission chemotherapy,including those who received IA regimen(IDA 8-10 mg/m2/d,1st～3d,ara-c 100-200 mg/m2/d,1st～7d),DA regimen(DNR 40-60mg/m2/d,1st～3d,ara-c 100-200 mg/m2/d,1st～7d),CAG regimen[ACL 7mg/m2/d,1st～8d(or 14mg/m2/d,1st～4d),ara-c 20mg/m2/d,1st～14d).G-csf 300ug,150ug/Q12h,0～14d]were 19 cases,13 cases and 7 cases,respectively.The complete response rate(CR),total response rate(ORR),total survival period(OS),recurrence free survival period(RFS)and adverse reactions of patients with different induction schemes were compared.After entering consolidation stage,19 patients were chosen to cytarabine(Ara-C)on the basis of chemotherapy,which accept large dose Ara C(2g/m2≤Ara-C≤3g/m2,Q12h1 times,1,3,5 days)there are 7 cases of patients,dose of Ara-C(1g/m2≤Ara-C<2g/m2,Q12h1 times,],3,5 days)patients in 12 cases,contrast different consolidation scheme in patients with continuous relief time,early recurrence,relapse-free survival(RFS);To analyze the prognostic factors of elderly patients with AML.Results:1.A total of 21 patients(53.8%,21/39)with CR and 4 patients(10.3%,4/39)with PRR(64.1%,25/39)received CR after 1 course of induction chemotherapy in 39 elderly patients(non-m3).The median OS was 10.8 months,6 patients had OS>for 24 months,the 2-year OS rate was 15.4%(6/39),the median RFS was 6.5 months,the 2-year RFS rate was 10.3%(4/39),and the early mortality was 15.4%(6/39).There were 19 cases of IA,13 cases of DA and 7 cases of CAG in 39 elderly AML patients.The CR rate of IA,DA and CAG regimen for one course of treatment was 57.9%(11/19),53.8%(7/13)and 42.9%(3/7),and the ORR rate was 73.7%(14/19),61.5%(8/13)and 42.9%(3/7),respectively.The difference between IA and CAG the two groups was statistically significant(P<0.017).The median OS of IA,DA and CAG schemes was 11 months,12.5 months and 8.5 months,respectively,and the 2-year OS rate was 15.7%(3/19),15.4%(2/13)and 14.3%(1/7),respectively.The median RFS was 7.4 months,6.6 months and 5.3 months,respectively,and the 2-year RFS rate was 10.5%(2/19),7.7%(1/13)and 14.3%(1/7),respectively.The early mortality was 15.8%(3/19),15.4%(2/13)and 14.3%(1/7),respectively.There was no statistically significant difference between the groups in the mean OS,mean RFS and early mortality(P>0.05).Comparison of adverse reactions after chemotherapy with IA,DA and CAG regimen,including duration of neutropenia less than 0.5×109/L(granulocyte deficiency),lung infection,perianal infection,bloodstream infection,gastrointestinal reaction,liver function damage,cardiac dysfunction,arrhythmia,oral ulcer,rash and hair loss,etc.Among them,cardiac dysfunction and gastrointestinal reactions were significantly reduced in the CAG regimen compared with the DA regimen,with statistically significant differences(P<0.017).The incidence of other adverse reactions in CAG regimen was lower than that in IA and DA regimen.2.1n the stage of consolidation and strengthening,among the 19 elderly AML patients,7 patients were selected to receive high dose of ara-c,and the median age of the patients was 66(60～71)years old,while the median age of the patients was 74(64～78)years old in the ara-c group.The sustained response time,disease-free survival rate and early recurrence rate of patients in the high-dose ara-c group and the medium-dose ara-c group were compared.The median sustained response time of the two groups was 9.5 months and 6 months,the early recurrence rate was 14.3%(1/7)and 33.3%(4/12),and the 2-year RFS rate was 42.9%(3/7)and 8.3%(1/12),respectively.There were statistically significant differences in 2-year RFS between the two groups(P<0.05),but no statistically significant differences in early recurrence rate and median sustained response time between the two groups(P>0.05).Compare two groups of patients with adverse reaction after chemotherapy(chemical conjunctivitis,grain of short duration,cardiac insufficiency,ataxia,pulmonary infection,sepsis,severe nausea and vomiting,the digestive tract ulcer and crissum infection,liver function damage,skin rash,and hair loss),the dose of Ara-C groups were significantly lower the incidence of the adverse reactions of high-dose group,but there was no statistically significant difference(P>0.05).3.39 elderly patients with AML were divided into four groups according to cytogenetics and molecular biology,including good prognosis,medium prognosis,poor prognosis and unmeasured prognosis,4 cases,26 cases and 5 cases.The median OS was 18.1,13 and 4.5 months.Compared with patients in the poor prognosis group,patients in the good prognosis group and the medium prognosis group had significantly longer survival,and the difference was statistically significant(P=0.001,P=0.011).The survival period of patients in the good prognosis group was longer than that in the medium prognosis group,but the difference between the two groups was not statistically significant(P=0.334).4.This group of elderly patients with AML’s age,gender,PS score,CCI ratings,peripheral blood leukocyte count(WBC)to begin with,hemoglobin(HGB),platelet count(PLT),the proportion of primitive bone marrow cells,serum lactate dehydrogenase(LDH),albumin(propagated)levels,risk stratification,CD117,CD34 expression in survival analysis for single factor related to factors.The results showed that PS score(2),serum LDH level(500U/L)and risk stratification were related to the prognosis of patients,and the difference was statistically significant(P<0.05).5.COX proportional risk model multivariate analysis showed that high PS score and poor prognosis were independent risk factors affecting the prognosis of patients in this group(P<0.05).Conclusions:1.For the standard remission chemotherapy for elderly AML patients in this group,IA regimen had the highest CR rate,followed by DA regimen,and CAG regimen had the lowest CR rate.The median OS and RFS of both IA and DA schemes were higher than those of CAG scheme,but the adverse reaction rate of CAG scheme was significantly lower than that of IA and DA scheme.2.In the consolidation and strengthening stage,the patients with high dose of ara-c had a long duration of continuous remission,high 2-year RFS and low recurrence rate.The patients with medium dose of ara-c had a low incidence of adverse reactions after chemotherapy,and were more tolerable,but had a high recurrence rate.3.Patients in the elderly AML group with good prognosis and medium prognosis had a longer survival period than those in the poor prognosis group.4.PS score(2 points),serum LDH level(500U/L)and risk stratification(poor prognosis)are risk factors affecting the prognosis of elderly AML patients.5.High PS score(2 points)and risk stratification(poor prognosis)are independent risk factors affecting the prognosis of elderly AML patients. |
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