老年急性非淋巴细胞白血病23例临床分析

兰晓曦++++++孙婉玲++++++惠吴函++++++赵弘

[摘要] 目的 探讨老年急性非淋巴细胞白血病的临床特征及合理治疗方案。 方法 回顾性分析2012年7月～2015年6月首都医科大学宣武医院血液科23例老年急性非淋巴细胞白血病患者的临床资料，按个体情况及治疗意愿分为姑息治疗组（5例）、去甲氧柔红霉素联合阿糖胞苷标准诱导化疗方案（IDA方案）组（5例）、低剂量阿糖胞苷和阿克拉霉素联合粒细胞集落刺激因子诱导化疗方案（CAG预激方案）组（9例）和小剂量化疗方案组（4例），对其生存率及不同治疗组的疗效进行比较。 结果 23例患者中位生存时间为10个月，姑息治疗组为0.75个月，接受化疗组为16个月。接受化疗组完全缓解率达66.7%，总生存率显著高于姑息治疗组（P < 0.01）。IDA方案组及CAG预激方案组总生存率明显高于小剂量化疗组患者（P=0.021）。 结论 IDA方案与CAG预激化疗对于老年急性非淋巴细胞白血病患者有较好的治疗效果。

[关键词] 老年；急性非淋巴细胞白血病；完全缓解率；生存期

[中图分类号] R733.71 [文献标识码] A [文章编号] 1674-4721（2016）09（a）-0068-04

[Abstract] Objective To investigate the clinical characteristics and reasonable treatment of acute non-lymphocytic leukemia in elderly patients. Methods The efficacy and overall survival of 23 patients who were newly diagnosed acute myelocytic leukemia in Department of Hematology， Xuanwu Hospital， Capital Medical University from July 2012 to June 2015 and were treated with palliative care （n=5）， standard-dose idarubicin combined with cytarabine （IDA） regimen （n=5）， combination of low-dose cytarabine， aclarubicin and granulocyte colony-stimulating factor priming （CAG） regimen （n=9）， or reduced-dose chemotherapy （n=4）， according to the individual condition and the will were analyzed retrospectively. Results The median survival time of 23 patients was 10 months. The median survival time in the group of receiving palliative care and the group of receiving chemotherapy were 0.75 month and 16 months， respectively. The complete remission rate in the group of receiving chemotherapy was 66.7%. Overall survival rate in the the group of receiving chemotherapy was significantly higher compared to which in the group of receiving palliative care （P < 0.01）. The overall survival in the group of receiving CAG regimen and receiving IDA regimen was significant higher compared which in the group of receiving reduced-dose chemotherapy （P=0.021）. Conclusion IDA regimen and CAG regimen has better clinical efficacy for elderly patients with acute non-lymphocytic leukemia.

[Key words] Elderly patients； Acute non-lymphocytic leukemia； Complete remission rate； Overall survival

大约65%的急性非淋巴细胞白血病（AML）患者在诊断时年龄大于60岁[1]，其诊断中位年龄大约为70岁，而且几乎1/3新诊断的AML患者超过75岁[2]，在这些患者年龄组，该疾病对治疗反应较差，在标准诱导化疗后的第1个月内，其死亡率约为15%，预期中位生存不超过1年[3]。国内成人AML（非急性早幼粒细胞白血病）诊疗指南（2011年版）建议60～75岁临床一般情况较好患者行标准剂量诱导化疗或联合粒细胞刺激因子的小剂量诱导化疗，年龄大于75岁患者建议行联合粒细胞刺激因子的小剂量诱导化疗或支持治疗。随着科技和文明的进步、全民医疗保险逐步的实现，我国社会人口老龄化日益明显，因此对于老年急性白血病患者的治疗意义重大。本研究回顾性分析了2012年7月～2015年6月首都医科大学宣武医院（以下简称“我院”）血液科收治的病历完整的23例初治老年AML（非急性早幼粒细胞白血病）患者临床资料。现报道如下：