Therapeutic Effects Of Different Regimens For Induction Therapy In Elderly Patients More Than 50 Years Old With Newly Diagnosed Acute Myeloid Leukemia

BackgroundAcute myeloid leukemia(AML)is the most common malignant disease of the blood system in adults.The incidence rate increases with age,the median age of diagnosis is 64 years old,which means more than half of the patients are elderly.Due to the poor physical condition,comorbidities,and high rate of natural resistance to chemotherapy,the outcome of elderly patients remains poor with a median overall survival of less than one year.In the past few decades,the standard induction therapy of AML remains the classic "7+3" regimen,namely cytarabine combined with anthracyclines.The emergence of demethylating drugs such as decitabine and azacitidine has changed this pattern.Clinically,a combination chemotherapy regimen based on demethylating drugs has emerged,and patients are well tolerated.At present,many studies on new drugs are underway,such as FLT3-ITD inhibitors,IDH1/IDH2 inhibitors and CPX-351,which may brought hope to the improvement of patients’ prognosis.At present,however,elderly AML patients still face the dilemma of low remission rate and poor long-term survival.This study compared the outcome of three commonly used induction chemotherapy regimens in order to provide more evidence for clinical medication.ObjectiveTo observe three clinical commonly used induction chemotherapy regimens,namely IA(idarubicin plus cytarabine)regimen,DCAG(decitabine,cytarabine,aclarubicin,and G-CSF)and DA(daunorubicin plus ytarabine)regimen on the efficacy,adverse effects,and prognosis of patients with AML(excluding APL)who were initially enrolled at age ≥50 years.MethodsWe retrospectively analysed the clinical data of 86 AML patients aged ≥50 years old admitted at the First Affiliated Hospital of Chongqing Medical University and the Second Affiliated Hospital of Chongqing Medical University.The patients were divided into three groups,Among them,19 were into IA group,36 into DCAG group,and 31 into DA group.Patients’ adverse reactions,complete remission(CR)rates,overall response(OR)rates,and long-term survival conditions were compared.ResultsThe CR rates of the IA group,DCAG group,and DA group were 47.4%,54.3%,and 42.9%,respectively(P = 0.659),and the OR rates were 52.6%,71.4%,and 71.4%,respectively(P = 0.311).The median survival time of the IA group was 12.47 months,while that of the DCAG group was 28.6 months(P = 0.180).All of the above results had no statistical difference.However,the DCAG group had lower incidence of haematological adverse reactions,fever,and gastrointestinal response of grade II or above than the DA Group and IA group.ConclusionThis study showed that IA regimen,DCAG regimen and DA regimen have similar therapeutic effects on patients aged ≥50 years old with newly diagnosed AML while DCAG regimen shows fewer adverse reactions.Patients with a age older than 70 years and a proportion of bone marrow blasts greater than 70% have a poor prognosis.