Objective: To analyze the difference of efficacy and prognostic factors between MA and CAG induction chemotherapy in elderly acute myelogenous leukemia (AML) patients.
Methods: From April 2009 to September 2015, 103 consecutive hospitalized 60-plus-year-old AML patients were retrospectively analyzed. NPM1 positive FLT3-ITD negative accounted for 17 cases (16.7%). Sixty-five patients received MA regimen and thirty-eight patients received CAG regimen. MA group had higher WBC and FLT3-ITD positive mutations at diagnosis compared with CAG group (P=0.001, P=0.005; respectively). The median follow-up was 13 months for all patients and 17 months for the survivors.
Results: Six patient (5.8%) died in early phase. Complete remission (CR) rate after the first cycle of induction chemotherapy was 51.5% (50/97). Overall CR rate was 70.1% (68/97). CR rate after the first cycle of induction chemotherapy and overall CR rate were indiscriminate between MA and CAG regimen. The time to neutrophil count recovery, the time to platelet count recovery and the number of platelet transfusions were indiscriminate between MA and CAG regimen. Among 68 CR patients, 23 patients relapsed at median 9 months, and cumulative incidence of relapse (CIR) at 3 years was (52.5±10.1)%. Median overall survival (OS) was 20 months. OS rate at 3 years was 32.2%. Median disease-free survival (DFS) was 28 months. DFS rate at 3 years was 43.7%. CIR, DFS and OS at 3 years were indiscriminate between MA and CAG regimen. Multivariate analysis showed that less than 70 years of age (P=0.001), achieved CR (P<0.001), and NPM1 (+) FLT3-ITD(-) mutation (P=0.044) were the independent factors for increasing OS. NPM1(+) FLT3-ITD(-) mutation was the independent factor for increasing DFS (P=0.042). Patients were classified by three prognosis factors: <70 ages, CR, and NPM1(+)FLT3-ITD(-) mutation. Patients with no poor prognosis factors were classified as low risk (n=13), with one factor as medium risk (n=52) and with two and more factors as high risk (n=31). There were significant differences in OS rate and DFS rate at 3 years for 3 groups patients (60.5% vs 48.1% vs 0, P<0.001; 60.2% vs 39.4% vs 0, P=0.045; respectively). OS and DFS at 3 years for 3 groups' patients were indiscriminate between MA and CAG regimen.
Conclusions: There was indiscrimination of efficacy among MA and CAG induction chemotherapy in old AML patients. Less than 70 years of age, CR and NPM1(+)FLT3-ITD(-) mutation were the independent factors for better survival.
目的: 分析老年急性髓系白血病（AML）患者采用小剂量MA（米托蒽醌、阿糖胞苷）与CAG（阿克拉霉素、阿糖胞苷、G-CSF）方案诱导治疗的疗效差异及预后影响因素。
方法: 回顾性分析2009年4月至2015年9月北京大学血液病研究所连续收治的103例≥60岁的确诊AML患者临床资料。其中，NPM1+FLT3-ITD−者占16.7%（17/102），65例采用小剂量MA方案诱导化疗，38例采用CAG方案诱导化疗，达完全缓解（CR）者进入巩固治疗。与CAG组相比，小剂量MA组患者发病时WBC显著升高（P=0.001），FLT3-ITD+患者比例显著升高（P=0.005）。全部患者中位随访13个月，存活患者中位随访17个月。
结果: 6例（5.8%）患者发生早期死亡，50例（51.5%）患者在1个疗程诱导化疗后获得CR，总CR率为70.1%。小剂量MA与CAG组1个疗程CR率及总CR率差异无统计学意义，停化疗后两组患者中性粒细胞恢复时间、血小板恢复时间及血小板输注次数差异均无统计学意义（P值均> 0.05）。68例CR患者中，23例（33.8%）在中位9个月时复发，3年累积复发率（CIR）为（52.5±10.1）%。全部患者中位总生存（OS）时间为20个月，3年OS率为32.2%，CR患者中位无病生存（DFS）时间为28个月，3年DFS率为43.7%。小剂量MA与CAG组患者3年CIR、中位OS时间、OS率、中位DFS时间、DFS率差异均无统计学意义（P值均>0.05）。多因素分析显示，年龄<70岁（P=0.001）、最终CR（P< 0.001）、伴随NPM1+FLT3-ITD−基因表达（P=0.044）是影响患者OS的独立预后因素。伴随NPM1+FLT3-ITD−基因表达是影响患者DFS（P=0.042）的独立预后因素。按照年龄<70岁、最终CR及伴随NPM1+ FLT3-ITD−基因表达三个独立预后因素进行危险度分层，无不良预后因素为低危（13例），具备1个不良预后因素为中危（52例），具备2个及2个以上不良预后因素为高危（31例），三组患者3年OS率和DFS率差异有统计学意义（分别为60.5%、48.1%和0，P<0.001; 60.2%、39.4%和0，P=0.045），小剂量MA与CAG组比较，在低危、中危及高危患者中的3年OS率和DFS率差异均无统计学意义（P值均>0.05）。
结论: 老年AML患者应用CAG与小剂量MA诱导治疗方案疗效近似，年龄<70岁、最终CR及伴随NPM1+FLT3-ITD−基因表达是老年AML患者生存的独立良好预后因素。