| Objective: 1.There are a good deal of factors that affect the prognosis of leukemia. For refractory and relapsed leukemia, the most important factors to predict the prognosis are the time to reach complete remission and persistent period of complete remission. At present, if a patient hasn't got complete remission after two periods of standard chemotherapies, he will be diagnosed as refractory leukemia. However, in the clinical works, a good many of cases are those without complete remission at the first time. This paper is to discuss whether there are significant differences in the curative effect, survival and prognosis between the cases which got complete remission at first time and that of the second time. And if a patient hasn't got complete remission at the first time, whether or not he could be diagnosed as refractory leukemia. 2. After the classic DA (Daunorubicin and Cytarabine) induction chemotherapy, 50-70% AML patients can get complete remission. But there is still a good portion of patients who cannot get complete remission. Most patients will finally develop into refractory and relapsed leukemic ones which is the most important reason for the failure of treatment. How to increase the complete remission rate and prolong the paracmasis is the formidable problem in clinical works. when patients of leukemia get relapse, it is one big problem whether to use the primary regimen or change it to a more intensive one. There are many regimens for the refractory and relapsed acute myeloid leukemia but without an optimal one. According to the reports at home and abroad, the main regimens include IDA, MA, MEA, and the ones containing intermediate dose cytarabine chemotherapy. But they lack comparison between the regimens, and there is little comparison between the side effects and long-term results. We summarize all the refractory and relapsed cases which usedIDA, intermediate dose cytarabine and etoposide regimens, comparing the curative effect, together with the side effects and prognosis. Our objective is to find out the optimal regimen for the refractory and relapsed acute myeloid leukemia and to guide the clinical treatment.Methods: All the cases involved in this study are from the hospitalized patients from 1994 to 2007 in our hospital. The deadline of follow-up in hospital is cut to February 1st, 2007. All the cases were definitely diagnosed as acute myeloid leukemia according to the clinical manifestation, hemogram, bone marrow aspiration and cytochemical staining. (1). Pick out randomly 100 cases that got complete remission at the first time of treatment to make up group C1. Meanwhile 78 patients who didn't get CR after the first treatment make up group N1. 21 patients who didn't get CR after twice treatments form group N2 and 47 patients who got CR after twice treatments form group C2. We made comparisons separately between group C1 and N1, group C1 and N2, group C1 and C2, group N1 and N2. We want to evaluate whether the fact that a patient could not get CR after the first treatment could be a prospective index for the diagnosis of refractory leukemia. (2). According to the classic refractory and relapsed diagnostic criteria, the patients who didn't get CR after the first treatment are at the same time brought into the refractory range, altogether there are 170 refracory and relapsed cases, including 76 relapsed cases and 94 refractory ones. 125 patients who used IDA, intermediate dose cytarabine and etoposide (VP-16) regimens are divided into three groups (IDA, intermediate dose cytarabine, VP-16) according to different regimens. Compare the curative effects, side effects and prognosis between different groups. Comparison between different treatment groups were done by means of the chi-squared test with Yate's correction, the t-test, the Wilcoxon rank-sum test and the log-rank test. Survival estimates were producedby Kaplan-Meier analysis. P<0.05 displays significant difference.Results: 1. Compared with the refractory patients, patients who get CR after the first treatment have lower death rate and longer life span. 2. Compared with the patients who get CR after the first treatment, patients who didn't get CR after the first treatment have higher death rate and shorter life span. 3. Compared with patients who get CR after the first treatment, patients who get CR after two treatments have higher relapse rate. The lasting period of complete remission and median life span are obviously decurtated. After relapsed, the curative effects are similar between two groups, but group C1 seems to have higher CR rate and effective rate. 4. The results show that group N1 and group N2 have similar curative effects, side effects, death rate and long term survival (P>0.05). 5. The CR rate and effective rate: The CR rate of IDA group was 40.6%, the effective rate was 55.1%. The CR rate of intermediate dose cytarabine group was 51.4%, the effective rate was 67.6%. The CR rate of VP-16 group was15.8%, the effective rate was 36.8%. The IDA and intermediate dose cytarabine group have similar CR rate and effective rate (P>0.05). They both are better than VP-16 group (P<0.05). 6. Analyze the CR rate and the correlation factors: Different factors didn't affect the prognosis(P>0.05).7. Compare the side effects: IDA group and intermediate dose cytarabine group have similar bone marrow suppression (P<0.05). Intermediate dose cytarabine group had the severest non-hematological system side effects. 8. Supportive care comparison: IDA group patients had more red blood cells transfusion. 9. Analysis of the survival state: IDA group and intermediate dose cytarabine group had longer median survival time than VP-16 group (P<0.05). IDA group had longer mean survival time.Conclusion: 1. It is thought that the fact that a patient not getting CR after the first treatment could be considered to predicte the refractory case. 2. For thetreatment of refractoy and relapsed AML patient, the optimal regimen is IDA. But for older and patients with poor general condition, intermediate dose cytarabine regimen is recommended. VP-16 regimen has lower CR rate and shorter survival time, so it is not recommended only if the patient can't tolerant the IDA and intermediate dose cytarabine regimens. |
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