AA And DA Chemotherapy Regimens In The Treatment Of Middle Aged And Elderly Untreated Acute Myeloid Leukemia Clinical Analysis

Background:Acute myeloid leukemia whose feather is immature (original cell and promyelcocyte) of malignant clonal proliferation of hematopoietic cells in the blood disease, its incidence is very dangerous, is a very dangerous and high popular of malignant tumors. The pathogenesis of acute myeloid leukemia is due to stagnation of leukemia cells at a stage in cell development and lose the potential of further matured, apoptosis is restrained, leukemia cells in the hematopoietic tissue and bone marrow hyperplasia, limite the growth of normal hematopoietic cells, damage or infiltraton other tissues and organs.Currently, widely used in clinical treatment of acute myeloid leukemia is combined chemotherapy.With the development of new drugs, gradual optimization of treatment plan and strategy, improvement of cure rate, support treatment condition improvement, the treatment of acute myeloid leukemia effect achieved significantly improved. The reported of inland and abroad that complete response rate of acute myeloid leukemia (compleate remission, CR) can be greater than65%, even reach85%The risk factors of Immunology, genetics, initial treatment of WBC number, age is related to the prognosis of acute myeloid leukemia provides instructional stratification treatment. At present stage, in the treatment of acute myeloid leukemia treatment method, the standard of induced joint cytarabine is anthracycline-based drugs. According to the large study of abroad show that the induced relief process, improve the dose cytarabine remission rate of acute leukemia, but the median time extended. With the continuous development of anthracycline-based drugs, the clinical curative effect has become the hot topic in the present study, there is no evidence that any early anthracycline-based drugs to treat the acute myeloid leukemia, most experts always adopt DA、IA、MA etal projects, but the report as for AA project (aclarubicin+cytarabine) to treat the initial treatment acute myeloid leukemia is less.Purpose:In this study, the clinicial data of middle-aged and old108AML patients in the First Affiliated Hospital of Zhengzhou University Department of Hematology from September2009to September2012were analyzed retrospectively. Using the comparision of DA regimen and AA regimen to clarify the AA regimen as induction remission for clinical efficacy,adverse reaction,provide the basis for the future clinical work.Materials and Methods:1. Research Object:108cases are middle-aged the initial treatment acute myeloid leukemia were treated in first affiliated hospital of zhengzhou university hematology,59patients received DA regimen,49patients received AA regimen.2. Compare the rate of complete remission(CR),the total efficiency(OR, complete response rate and partial response rate) of AA project and DA project.,compare the two groups of different genetic risk stratification of patients of rate of complete remission(CR),the total efficiency,compare the different aged of patients of rate of complete remission(CR),the total efficiency,and compare the two groups of hematologic toxicity and non-hematologic toxicity. 3. Application SPSS17.0for statistical analysis, the groups were compared using T test or X2test, P<0.05for the difference was statistically significant, the measurement data are expressed as mean+standard deviation.Result1. General information:108cases of acute myeloid leukemia patients,58male (53.7%),50female(46.3%), male:female=1.12, aged35-67years old, average50years old.;59patients receive DA project,49patients receive AA project;in AA project, Mo in2cases, M1in3case, M2in37case, M42cases, M55cases;in DA project, Mo in3cases, M1in4cases, M2in45cases, M43cases, M54cases. Two groups of patients were Initial treatment acute myeloid leukemia, no significant difference in age, sex, type of leukemia, age, genetics, risk stratification.2. Comparison of efficacy:108patients after chemotherapy efficacy of complete remission is67cases (62%), partial remission is13patients (12%), the total efficiency is74%. AA group of patients with complete remission is30patients (61.2%), partial remission is7patients (14.3%), the total efficiency is75.5%, the DA group complete remission in patients is37cases (62.7%), partial remission is6cases (10.1%), with a total efficiency of72.8%, the two groups of patients in complete remission rate and total efficiency compared not statistically significant.108patients can be divided into high-risk5people, the crisis82person,21low-risk as the cytogenetic stratification, in which the DA group, high-risk3cases, medium risk,44cases,low-risk12cases, AA group of high-risk2cases, medium risk38cases,low-risk9cases. one high-risk patient of DA group reached complete remission,one patient reached partial remission, one patient did not ease; one high-risk patient of AA group reached complete remission,one patient did not ease;The two groups of patients with high-risk group compared with no significant.During the low-risk patients,19patients(90.4%) reach complete remission, one case (4.8%) reach partial remission, the total efficiency is95.2%;during the middle-risk patients,46patients (56.1%)reached complete remission,11patients (13.4%) reached partial remission, and the total efficiency is69.5%, was statistically significant in the two groups of patients in complete remission rate and total efficiency. During the middle-risk patients of AA project,21cases (55.2%) reached complete remission,6cases (15.9%) reached partial remission,the total efficiency is71.1%, During the middle-risk patients of DA project,25cases (56.8%) reached complete remission,5cases (11.3%) reached partial remission,the total efficiency is68.1%, was not statistically significant in the two groups of patients in complete remission rate and total efficiency. During the low-risk patients of AA project,8cases (88.9%) reached complete remission,1cases (11.1%) reached partial remission,the total efficiency is100%, During the low-risk patients of DA project,11cases (91.7%) reached complete remission,0cases (0%) reached partial remission,the total efficiency is91.7%, was not statistically significant in the two groups of patients in complete remission rate and total efficiency.108cases of acute myeloid leukemia patients were divided into two groups according to age:≥60years of age is37cases,15cases (40.5%) reached complete remission,5cases (13.5%) reached partial remission, the total efficiency is54%,the number of age<60years is71,52cases (73.2%) reached complete remission,8cases (11.3%) reached partial remission,the total efficiency is84.5%, the two groups of patients in complete remission rate and total effective compared statistically significant, P<0.05. The number of AA group aged≥60years is16cases,6cases (37.5%) reached complete remission,2cases (12.5%) reached partial remission, the total efficiency is50%, the number of DA group aged≥60years is21cases,9cases (42.8%) reached complete remission,3cases(14.3%) reached partial remission, the total efficiency is57.1%, the two groups of patients in complete remission rate and total efficiency difference was not statistically significant; The number of AA group age<60years is33cases,24patients (72.7%) reached complete remission,5cases (15.1%) partial remission, total efficiency is87.8%, the number of DA group age<60years is38cases,28cases (73.7%) reached complete remission,3cases (7.9%) reached partial remission, the total efficiency is81.6%two groups of patients in complete remission rate and total efficiency difference was not statistically significant.3. Adverse reactions:different Aml patients were expressed by hematologic adverse reactions and non-hematologic adverse reactions, hematologic adverse reactions mainly expressed bone marrow suppression, the white blood in patients of DA group of with a minimum value of0.7±0.5×109/L, the time required is11.9±4.8days,the time of agranulocytosis is13.4±4.6days,the lowest hemoglobin value is52.6±7.2g/L,the days of hemoglobin<60g/L is19.6±6.3days,the days of peripheral blood platelet reduced to less than20×109/L is14.9±3.7days,lasted for12.6±5.5days, the white blood in patients of AA group of with a minimum value of0.9±0.6×109/L, the time required is12.3±5.2days,the time of agranulocytosis is12.7+4.9days,the lowest hemoglobin value is57.6±6.9g/L,the days of hemoglobin <60g/L is17.8±5.7days,the days of peripheral blood platelet reduced to less than20×109/L is14.4±5.3days,lasted for10.2±6.7days,the two groups were compared the difference was not statistically significant. Non-hematologic mainly include nausea,vomiting, abnormal liver function,oral ulcers, cardiac enzymes etal, specific for the DA group had57cases of infection,the proportion is96.6%,the number of nausea, vomiting is47cases, the proportion is79.7%,the number of abnormal liver function, is12cases, the proportion is20.3%,seven cases of oral ulcers, a ratio of11.9%,nine cases of heart damage, the ratio was15.3%, the number of hemorrhage is37cases, the ratio was62.7%,the number of bloating is15cases, the ratio was25..4%,50case of hair loss,the proportion is84.7%. AA group had46cases of infection,the proportion is93.8%,the number of nausea, vomiting is38cases, the proportion is77.6%,the number of abnormal liver function, is9cases, the proportion is18.4%,5cases of oral ulcers, a ratio of10.2%,1cases of heart damage, the ratio was2%, the number of hemorrhage is29cases, the ratio was59.1%,the number of bloating is12cases, the ratio was24.4%,39case of hair loss, the ratio was79.5%.The two groups were compared in terms of cardiac injury was statistically significant, P<0.05; while the other was no significant difference.Conclusions:1. DA, AA anthracene ring chemotherapy regimen in middle-elderly patients with acute myeloid leukemia complete remission rates were similar, low-risk patients compared with cytogenetic risk patients with clinical efficacy, age<60years compared with age≥60years of clinical efficacy good.2. The adverse reactions of cardiac toxicity in AA chemotherapy is weaker than the DA program and is suitable for popularization and application.