Result Of Comparing Cytarbine And Daunorubicin With Cytarbine And Idarubicin Or Cytarbine And Homoharringtonince In Pations With Acute Myeloid Leukemia

Leukemia is a malignancy with the clonal expansion of hematopoietic progenitor cells,and the incidence rate of acute myelogenous leukemia(AML) is the first in all sorts of leukemia(1.62/100,000).Chemiotherapy makes many pations gotten response of disease and have a long survival. It is the most importance in the treament of leukemia to increase complete response(CR) and survival,and decrease the complications of treatment. This article carried out retrospective analysis from January 1995 to January 2003 in our hospital focused on 125 patients with AML who were newly diagnosed disease and 57 patients who were relapsed or refractory AML. The previously untreated pations with AML were randomized to receive for induction therapy cytarabine 100 mg/m2/d as a continuous 7-day infusion plus daunorubicin 45 mg/m2/d (A + D) daily on the first three days of treatment or idarubicin 10-12 mg/m2/d (A + I) on the first 3 days or homoharringtonine 4-6mg/m2/d for 7 days (A+H).We compared with the CR rates, survival,toxicity, complete response duration and cost effectiveness analysis of HA,DA ,IA,refractoryIA(rIA),relapsedDA(rDA). Results are as follows: The CR rates were 82.85% (IA), 61.54% (DA) , 57.58% (HA),52.78% (rIA),23.81%(rDA). Days of attaining the CR were 31 days(IA), 42 days(DA) and 31days(HA), respectively.The average course of CR with HA,DA,IA were 1.6±0.63, 1.58±0.61 and 1.12±0.33, respectively.The median suvival of the CR pations were 369 days (IA),288days (DA) and 276 days (HA),81 days(rIA), 59 days(rDA), and the median CR duration (294 days, 255 days, 241 days,96 days,63 days respectively). Toxicity of the three treatments was similar such as nausea/vomiting, mucositis, an increase in serum glutamic-oxalocetic transaminase and bilirubin, infections, congestive heart failure, arrhythmia, myelosuppression.And death rates of induced therapy were 25% (rIA), 38.10%(rDA). Hyperleukocytosis (white blood cell count greater than 10×109/L) unfavorably affected the attainment of CR with DA but not with IA. Both with IA and DA more than 60 ages unfavorably affected the attainment of CR, and infusion of PLT or RBC with IA were more than one with DA. The overall average hospital cost were ￥18582.6±5810.1 (DA),￥27947.1±7560.8 (IA) , respectively; and the one percent cost of gaining the CR in the iduced therapy were ￥301.96(DA) and ￥338.75(IA),but the one percent cost of gaining the CCR were ￥580.7(DA) and ￥400.96(IA), respectively. We conclude that IDR/Ara-C can effectively replace standard therapy with DNR/Ara-C, and HHT/Ara-c is the same efficiency with DNR/Ara-C.