| Objective:The aims of this thesis is to make a retrospective analysis of the clinical data about 43 elderly AML patients’ cases with their first treatment in Yan’an University Affiliated Hospital during October 2010 to October 2015. And at the same time, to make a comparison of the adverse reactions between TA and MA scheme with lower doses to untreated elderly patients with AML remission induction rate, hematologic and nonhematologic.Materials and methods:With reference to the FAB diagnosis and typing standard, the author wants to make a retrospective analysis of the initial treatment of elderly patients in Yanan University Affiliated Hospital from October 2010 to October 2015. All the patients are diagnosed as acute myeloid leukemia with the help of acute myeloid leukemia(non acute promyelocytic leukemia) patients and the bone marrow cytology, immunology and molecular biology. The process are done non-randomly which should be used the lower dose of mitoxantrone or pirarubicin with cytosine arabinoside regimen chemotherapy(hereinafter referred to as the MA group and TA Group). A total of 43 cases were selected to be given MA or TA regimen for remission induction chemotherapy non randomly. In the MA group(23 cases), 11 cases are male and 12 cases are female, with the age of 60 to 71 years, the average age is 64.09± 2.78 years old; In the TA group(20 cases), 12 cases are male, 8 cases are female, aged 60 to 70 years, and the average age is 63.95±3.17 years old. Group TA: pirarubicin 15-20mg/(m2·d), intravenous infusion, 1-3 days; cytosine arabinoside 75mg/(m2·d), intravenous infusion, 1-7 days. Group MA: mitoxantrone 2mg/(m2·d)), intravenous infusion, 1-3 days; Ara 75mg/(m2·d), intravenous infusion, 1-7 days. The author will compare the remission rate, hematologic and non hematologic adverse reactions after the first course of treatment.Result:1. In this study, the results of the first treatment of elderly patients with AML are as follows: In the MA group, there are a total of 23 cases, 14 cases are in complete remission, 4 cases are in partial remission, the rate of complete remission is 60.9 percent, the total effective rate is 78.3 percent. In the TA group of 20 cases: 10 cases are in complete remission, 3 cases are in partial remission, the rate of complete remission is 50 percent and the total effective rate is 65 percent. In comparison with the reduced dose of MA and TA of AML in elderly efficacy, group MA’s rate of complete remission and total efficiency is higher than that group of TA, but the differences are not statistically significant(P>0.05); there are one dead case in both two groups of early days(within 30 days). In this paper, 2 cases in both two groups are of high white blood cells in elderly patients with AML, all the 4 patients are not remitted.2. Chemotherapy in the treatment of hematologic adverse reaction is mainly bone marrow suppression, two groups of patients showed different degrees of bone marrow suppression.White blood cell toxicology of MA to III- IV percentage is 65.2 percent. Leukocyte hematologic toxicity of TA all reach III- IV. In group of MA, the level of hemoglobin in blood toxicity all reach III- IV. The level of hemoglobin in blood toxicity of TA is 90%. In terms of platelets, the blood toxicity of the two groups both reach the degree of IV. In group of MA, the inhibitory rate of white blood cells after chemotherapy is lighter than that group of TA, and there is some significant differences between the two groups(P<0.05). There is no significant differences between the two groups in hemoglobin and platelets,(P>0.05). The lowest value of white blood cell count is(1.69±0.86)×109/L, TA average is(1.13±0.45)×109/L. The group of TA is significantly lower than that group of MA, and the differences between the two groups are statistically significant(P<0.05). But in group of MA, after chemotherapy leukocyte count with a minimum average are 8.65±1.97 days, group TA includes 9.20±2.07 days; neutrophil counts less than 1.0×109/L in MA duration the average are 9.09±4.85 days, TA has 8.90±3.13 days. After comparison, there are no significant differences in two groups(P>0.05). The lowest average value of hemoglobin in MA are 62.52+11.37g/L, TA is 62.40±11.38g/L; The group of MA after chemotherapy hemoglobin with a minimum average are 9.74 ±1.98 days, TA has 9.65±1.73 days; hemoglobin in MA less than 80 g duration average is 12.09 ±2.45 days, TA contains 10.8±2.97 days; two groups have no significant differences(P> 0.05). The platelet with minimum average in MA is(2.78±3.83)×109/L, TA is(3.00 ± 2.25)×109/L; after chemotherapy the platelet count with a minimum in MA the average is 5.87±3.08 days, TA is 5.85±2.68 days; the platelet count less than 20×109/ L in MA continuous time average is 11.96+4.26 days, TA is 12.65±2.74 days; two groups have no significant differences(P>0.05). Therefore, the degree of inhibition of bone marrow in MA is lighter than that in TA.3. Non hematologic adverse reactions mainly lie in secondary infection. As to oral infection, rate of MA group is higher than the other, there are some significant differences(P<0.05). But there are no other significantly differences in the two groups. Other nonhematologic adverse reactions mainly include subcutaneous bleeding, ecchymosis, nose bleeding, liver function abnormal, but they are all relatively minor and all of them return to normal after treatment, and the differences between the two groups have no significance(P>0.05).Conclusion:1. The therapy of reducing the dose of MA and TA regimen are effective to the treatment of the elderly patients with AML in inducing remission, there are no significant differences between the two groups.2. The group of MA for hematologic adverse reactions are lighter than the group of TA after chemotherapy. As to the non hematologic adverse reactions, there are no other significant differences between the two groups apart from the aspect of oral infection in which MA is higher than the group of TA.3.AML of elderly patients is more suitable for the therapy with the lower dose of mitoxantrone with cytosine arabinoside. |
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