A Study On The Therapy Of Previously Untreated Elderly Patients With Acute Myeloid Leukemia

Objective:To compare the efficacy and toxicity between priming induction regimen(CAG regimen)and standard chemotherapy regimen(DA regimen)in elderly patients with acute myeloid leukemia by retrospective analysis.Materials and Methods:47 newly diagnose patients with AML who were diagnosed between November 2006 and September 2009 were enrolled in our hospital. the diagnostic criteria is based on Internal diagnostic criteria. The 47 cases were divided into groups with CAG regimen and DA regimen according to different chemotherapy, 21 patients were given CAG priming induction regimen and the other 26 were given DA standard chemotherapy regimen. According to different chemotherapy, we adopt two regimens to compare the efficacy and toxicity. We compared measurement data with t text or repeated measurement design,count data with x2 text, and calculated overall survival and progression-free survival with frequency tables, P<0.05 has statistic significance.Results:1. There were 21 cases treated with CAG priming induction regimen:the totally effective rate is 57.15%, complete remission 8(38.10%), partial remission 4(19.05%), non-remission 9(42.85%). There were 26 cases treated with DA standard chemotherapy regimen:the totally effective rate is 57.70%, complete remission 9(34.62%), partial remission 6(23.08%), non-remission 11(42.30%).The statistics analysis shows P=0.307 and P=0.058, which means there was no significant differences in totally effective rate and complete remission rate between the two groups.2. CAG priming induction regimen(13.15±2.89)×10~9/L is lower than DA standard chemotherapy regimen(42.90±12.76)×10~9/L in the declining level of white blood cells after chemotherapy, there was a significant difference in the declining level of white blood cells between the two groups, because the statistics analysis shows P=0.046, but there was no significant differences in the declining level of red blood cells and platelets between the two groups(P=0.069,P=0.926).3. In the bone marrow recovery time, CAG priming induction regimen needs(11.95±3.81)days, is more than DA standard chemotherapy regimen(18.81±2.61)days, the statistics analysis shows P=0.000, so there was a significant difference between them. The chemotherapy-related deaths in DA standard chemotherapy regimen is more than CAG priming induction regimen(P=0.034), but there was no significant differences in heating rate,bleeding incidence,bone marrow suppression incidence between the two groups(P=0.528,P=0.477,P=0.414).4. CAG priming induction regimen infused red blood cells and platelets in the number of units, respectively(4.95±2.73)u,(12.38±8.31)u, were less than the DA standard chemotherapy regimen(6.85±3.36)u,(20.00±9.83)u, by the statistics analysis, there was a significant difference between the two groups(P=0.043,P=0.006).5. In the course of chemotherapy, there was a significant difference of incidence rate of liver toxicity between CAG priming induction regimen 2(9.52%)and 11(42.31%), there was a significant difference between the two groups(P=0.012); the gastrointestinal reaction rate of CAG regimen was 12(57.14%),DA regimen was 25(96.15%), there was a significant difference between the two groups(P=0.001);and there were significant differences of incidence rate of cardiac toxicity,muscle soreness,hair loss and mucositis between the two groups(P=0.010,P=0.000,P=0.000,P=0.046); while there was no significant difference in renal toxicity(P=0.549).6. To study termination, with a median follow-up of 9 months(3～25months), all patients with a median OS was 8 months(0～25 months). Up to CR 17 patients were followed up PFS, median PFS was 9 months(5～21 months).CAG regimen Median OS was 9 months(0～25 months),with a median PFS was 9 months(5～21 month),of which 6 patients still no progression-free survival, and the relapse rate was 25.00%(2/8)at 5～20 months, 1 case still under treatment, the remaining 1 case had already died; DA regimen median OS was 8 months (0～23 months), median PFS 8 months(4～21 months), of which 2 patients still no progression-free survival, the relapse rate was 77.78%(7/9)in 4～20 months,1 case still under treatment, the remaining 6 patients have died. The relapse rate of the two groups have a significant difference by comparing their relapse(P = 0.030).7. In the 47 cases, 25 cases were tested with chromosome karyotyping, in which the CR rate of good or intermediate prognosis chromosome karyotyping group was 68.75%, significantly better than a poof prognosis group of CR rate of 11.11%, there was a significant difference between the two groups(P=0.006). The former median survival time(246d)was longer than the poof prognosis group(28d), there was a significant difference between the two groups(P=0.000).Conclusion:1. In the therapy of previously untreated elderly patients with AML, CAG priming induction regimen was to be as effective as DA standard chemotherapy regimen in totally effective rate and complete remission rate, but its intensity of chemotherapy is soft, bone marrow recovery time can be shortened to reduce chemotherapy-related death, reducing the number of blood transfusions to improve their living and the quality of life, it is well effective as an induction therapy in previously untreated elderly patients with AML.2. In addition to the muscle soreness of CAG priming induction regimen , other adverse reactions, such as the incidence rate of liver toxicity,gastrointestinal reaction,cardiac toxicity and so on were significantly less than the DA standard chemotherapy regimen, higher security, in general ,elderly patients may be tolerant.3. Elderly patients with AML adopting CAG priming induction regimen can reduce the relapse rate after CR when comparing with DA standard chemotherapy regimen.4. We can test with chromosome karyotyping to evaluate the prognosis of patients when conditions permit.