Analysis Of Clinical Efficacy Of Different Chemotherapy Regimen Containing Etoposide In The Treatment Of Relapsed And Refractory Acute Myeloid Leukemia

ObjectiveRetrospective analysis of clinical data of relapsed/refractory acute myeloid leukemia(R/R AML)treated with chemotherapy containing etoposide(VP-16)in our hospital from January 2014 to August 2019,analyze the clinical characteristics of patients,and evaluate the efficacy and prognostic factors of different salvage chemotherapy regimens based on etoposide for R/R AML.MethodsA total of 69 patients with R/R AML who were treated in the Department of Hematology of the First Affiliated Hospital of Nanchang University from January2014 to August 2019 were collected.According to the different chemotherapy regimens used by patients,they were divided into 3 groups,which were group A(ME regimen:mitoxantrone+cytarabine+etoposide,HEA regimen:homotaxine+cytarabine+etoposide),group B(DCEG regimen:decitabine+cytarabine+etoposide+recombinant human granulocyte colony stimulating factor)and group C(EDCAG regimen:etoposide+decitabine+aclacinomycin+cytarabine+recombinant human granulocyte colony stimulating factor).Collect patients’gender,age,blood routine,blood biochemistry,MICM’information,FAB typing,blood routine after recurrence,blood biochemistry,chest and abdomen examination(including CT or color ultrasound)and all the treatments of patients in the course record if our hospital,and follow up by telephone.Summarize and analyze the clinical characteristics,efficacy,adverse reactions,and prognostic factors of patients.Results1.Among all patients:37 cases in group A,11 cases in group B,and 21 cases in group C.There was no difference in age and gender between the three groups(P>0.05).The overall response rate(ORR)of group A was 46.0%,group B was 45.5%,and group C was 66.7%.There was no difference between the three methods in the treatment of R/R AML(Z=4.002,P>0.05).2.Subgroup analysis showed that:For female patients,the efficacy of group C was better.For young and middle-aged patients,group A was better.3.The median OS of the three groups were 5.5,4.1 and 7 months,respectively,and the differences were not statistically significant(P=0.167).4.Logistic regression model results showed that the proportion of bone marrow blasts≥75%,PLT<100×10~9/L at initial treatment and poor prognosis resulted in lower CR.It is suggested that the proportion of bone marrow blasts,PLT and prognostic stratification are factors of affecting CR.5.Whether CR is achieved after salvage treatment is related to prognosis.There was no correlation between age,newly treated leukocytes,LDH at the time of initial treatment,the proportion of bone marrow blasts,prognosis stratification and prognosis.6.All patients had various degrees of adverse reactions to the hematopoietic system.Among patients with pulmonary infections,75.7%were in group A,90.9%in group B,and 42.9%in group C.The proportion of lung infection in group C was significantly lower than the other two groups(P=0.01).Conclusion1.There is no statistical difference in the total effective rate and OS of the three treatment regimens containing etoposide in the treatment of relapsed and refractory acute myeloid leukemia,indicating that the three treatment regimens are equally effective and can be used as chemotherapy options for R/R AML patients Compared with adverse reactions after comprehensive chemotherapy,it was found that the EDCAG group had a lower chance of pulmonary infection and its medication safety was relatively higher.2.For female patients,EDCAG regimen is more effective.For young and middle-aged patients,treatment with MEA is more effective.3.The ratio of bone marrow blasts,PLT at initial treatment,and prognostic stratification were related to efficacy.4.Whether CR is achieved after salvage treatment is an independent risk factor affecting OS.