Efficacy of common salvage chemotherapy regimens in patients with refractory or relapsed acute myeloid leukemia A retrospective cohort study
Efficacy of common salvage chemotherapy regimens in patients with refractory or relapsed acute myeloid leukemia A retrospective cohort study
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DOI：
10.1097/md.0000000000012102
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发表时间：
2018-09-01
期刊：
影响因子：
1.6
通讯作者：
Yuan, Guo-Lin
中科院分区：
文献类型：
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作者：
Xu, Jun;Lv, Ting-Ting;Yuan, Guo-Lin
为评价难治性或复发性急性髓系白血病（R/R AML）患者常用挽救化疗方案的疗效和总生存期（OS），回顾性分析了142例R/R AML患者的临床资料。患者接受基于以下药物的治疗方案：阿糖胞苷、粒细胞集落刺激因子（G-CSF）和氟达拉滨（FLAG）（n = 46）;阿糖胞苷和G-CSF加阿罗格或柔红霉素（CAG/DAG）（n = 30）;阿糖胞苷、G-CSF和克拉屈滨（CLAG）（n = 27）;阿糖胞苷、依托泊苷和米托蒽醌（MEA）（n = 17）;阿糖胞苷+伊达比星、柔红霉素或米托蒽醌（IA/DA/MA）（n = 12）;高三尖杉酯碱、阿糖胞苷、阿克拉霉素或柔红霉素（HAA/HAD）（n = 10）。35.2%的患者达到完全缓解（CR），（49.2%）患者达到总体缓解率（ORR），CR后行异基因造血干细胞移植（allo-HSCT）18例（14.8%）。中位OS为8.0（95% CI 6.6 - 9.4）个月，1年OS率为（29.9 +/-3.9）%，3年OS率为（11.1 +/-3.6）%。不同化疗方案的CR（P =.621）、ORR（P =.385）和allo-HSCT（P =.537）实现率无差异。有趣的是，我们观察到基于CLAG的方案不影响CR（P = 0.165），而它实现了更高的ORR（P = 0.093），并且是OS延长的独立因素（P = 0.016）。未发现其他方案与CR、ORR或OS相关。发现基于FLAG、CAG/DAG、CLAG、MEA、IA/DA/MA和HAA/HAD的方案获得相似的CR率，而基于CLAG的方案获得了数值上更高的ORR率和显著有利的OS。因此，基于CLAG的方案应作为R/R AML患者的优先治疗选择。
To assess treatment response and overall survival (OS) in refractory or relapsed acute myeloid leukemia (R/R AML) patients treated by different common salvage chemotherapy regimens.Medical records data from 142 R/R AML patients were reviewed in this retrospective study. Patients were treated with regimens based on the following drugs: cytarabine, granulocyte colony-stimulating factor (G-CSF), and fludarabine (FLAG) (n=46); cytarabine and G-CSF in addition to aclarubicin or daunorubicin (CAG/DAG) (n=30); cytarabine, G-CSF, and cladribine (CLAG) (n=27); cytarabine, etoposide, and mitoxantrone (MEA) (n=17); cytarabine plus idarubicin, daunorubicin, or mitoxantrone (IA/DA/MA) (n=12); and homoharringtonine, cytarabine, and aclarubicin or daunorubicin (HAA/HAD) (n=10).A total of 43 (35.2%) patients achieved complete remission (CR), 60 (49.2%) patients achieved overall remission rate (ORR), and 18 (14.8%) patients received allogeneic hematopoietic stem cell transplantation (allo-HSCT) after CR. Median OS was 8.0 (95% CI 6.6-9.4) months with a 1-year OS rate of (29.9 +/- 3.9)% and 3-year OS rate of (11.1 +/- 3.6)%. No difference of CR (P=.621), ORR (P=.385), and allo-HSCT (P=.537) achievement was observed among different chemotherapy regimens. Interestingly, we observed that the CLAG-based regimen did not affect CR (P=.165), while it achieved a numerically higher ORR (P=.093) and was an independent factor for prolonged OS (P=.016). No other regimens were determined to be correlated with CR, ORR, or OS.FLAG-, CAG/DAG-, CLAG-, MEA-, IA/DA/MA-and HAA/HAD-based regimens were found to achieve similar CR rates, while the CLAG-based regimen achieved numerically higher ORR rates and significant favorable OS. Therefore, CLAG-based regimens should be a prioritized treatment option for R/R AML patients.