曹轶璇 柯鹏 宋通薇

【摘要】 目的：探讨米托蒽醌（Mito）联合中剂量阿糖胞苷（AraC）巩固化疗方案（MA）治疗急性髓系白血病（acute myeloid leukemia，AML）的效果。方法：选取2009年1月-2014年8月本院血液内科收治的66例初发AML患者的临床资料进行回顾性分析。根据巩固化疗方案不同将其分为MA组（n=44）和大剂量阿糖胞苷（high-dose cytarabine，HD-AraC）组（n=22）。MA组应用MA作为巩固化疗方案，HD-AraC组应用HD-AraC作为巩固化疗方案。随访5年，比较两组总生存时间、无病生存时间及粒细胞缺乏时间。结果：两组生存曲线在17个月时间点存在交叉。两组5年总生存时间及5年无病生存时间比较，差异均无统计学意义（P>0.05）。MA组粒细胞缺乏时间长于HD-AraC组（P<0.05）。MA组17个月前总生存时间和无病生存时间均短于HD-AraC组（P<0.05）。结论：MA巩固化疗方案早期死亡率较高，其对成人AML的远期疗效，需待进一步评价。

【关键词】 急性髓系白血病 米托蒽醌 阿糖胞苷

The Consolidation Effect of Mitoxantrone in Combination with Intermediate-dose Cytarabine and Analysis of Influence Factors in the Therapy of Acute Myeloid Leukemia/CAO Yixuan， KE Peng， SONG Tongwei. //Medical Innovation of China， 2021， 18（05）： -128

[Abstract] Objective： To investigate the efficacy of Mitoxantrone in combination with intermediate-dose Cytarabine （MA） consolidation chemotherapy in the treatment of acute myeloid leukemia （AML）. Method： The clinical data of 66 patients with newly diagnosed AML admitted to the department of hematology in our hospital from January 2009 to August 2014 were retrospectively analyzed. According to different consolidation chemotherapy regimen， the patients were divided into MA group （n=44） and high-dose cytarabine （HD-AraC） group （n=22）. MA group was used MA as the consolidation chemotherapy regimen， and HD-AraC group was used HD-AraC as the consolidation chemotherapy regimen. The total survival time， disease-free survival time and granulocytosis time were compared between the two groups. Result： The survival curves of the two groups intersected at 17 months. There was no significant difference in 5-year overall survival time and 5-year disease-free survival time between the two groups （P>0.05）. The time of granulocyte deficiency in the MA group was longer than that in the HD-ARAC group （P<0.05）. The overall survival time and disease-free survival time before 17 months in the MA group were shorter than those in the HD-AraC group （P<0.05）. Conclusion： MA consolidation chemotherapy regimen has a higher early mortality rate， and its long-term efficacy in adult AML needs to be further evaluated.

[Key words] Acute myeloid leukemia Mitoxantrone Cytarabine

First-authors address： Shenzhen Peoples Hospital， Shenzhen 518000， China

doi：10.3969/j.issn.1674-4985.2021.05.032

白血病是起源于造血干細胞的恶性克隆性疾病，受累的细胞出现增殖失控、分化障碍、凋亡受阻。其中累及髓系细胞分化，使之停滞于早期原始细胞和早幼稚细胞阶段，临床上称之为急性髓性白血病（acute myeloid leukemia，AML） [1]。米托蒽醌作为一线化疗药物应用于白血病治疗。其抗白血病活性高于柔红霉素，国外相关报道显示联合应用米托蒽醌与阿糖胞苷（MA方案）治疗AML取得了较好的效果。但米托蒽醌在白血病的治疗中表现为骨髓抑制期较长，使得其临床应用受到限制。故本研究对66例AML患者的临床资料回顾性分析，探讨MA巩固化疗方案的治疗效果，现报道如下。

1 资料与方法

1.1 一般资料 选取2009年1月-2014年8月本院血液内科收治的66例初发AML患者的临床资料进行回顾性分析。纳入标准：符合世界卫生组织（WHO）白血病分型确诊为AML（除外急性早幼粒细胞白血病）[2];细胞形态学和流式细胞学确诊为急性髓系白血病患者;预计生存时间大于3个月;美国东部肿瘤协作组（ECOG）评分≤2分。排除……