A Retrospective Study Of Individualized Chemotherapy In The Treatment Of Acute Myeloid Leukemia

Objective: Acute myeloid leukemia is a malignant tumor whichmalignant clones derived from hematopoietic stem cells were a group ofdisorders, with high heterogeneity, different subtypes in cell genetics,pathology, progression, and clinical characteristics, response to treatment andprognosis of each are not identical,and with the highest morbidity andmortality in youth.Combination chemotherapy is considered to be the currentremission induction treatment of AML, the internationally recognized standardof induction therapy of AML is anthracycline-based plus cytarabine "3+7"scheme, on the basis of this can increase the dose of cytarabine, or otheretoposide, fluorine dara marina and other drugs. Complete remission (CR) was60%-80%,50%-80%CR patients eventually become relapsed. Another studyfound that after one course of chemotherapy, original residues of bone marrowcells have important influence on the prognosis. Application in our hospital inrecent decades, the individualized treatment which under the monitoring ofthe bone marrow of acute myeloid leukemia has obtained certain curativeeffect.I hope this retrospective study, to explore individualized chemotherapyin the treatment of AML bone marrow monitored clinical effect,provide somevaluable reference for clinical treatment.Methods: The375cases of newly diagnosed AML patients fromJan.2004to Dec.2012were enrolled into this study. The diagnosis of thepatients through the bone marrow,morphology pathological fluid cytologyand fusion gene.Not for genetics prognosis grouping. Chemotherapy methodas follows: the cell cycle–specific agent cytarabine150mg/m~2and thenon–cell-cycle–specific anthracycline antibiotic daunorubicin30to45mg/m~2/d intravenously for3days. Five days later, if neutrophils in patientswith chemotherapy <0.5×10~9/L and co-infection,then take bone marrow examination.If already achieved bone marrow suppression, stop thechemotherapy, if not, continue chemotherapy until the seventh day.Withoutabove situation, take the standard chemotherapy for7days and review of thebone marrow, the inhibitor stop chemotherapy, failed to reach the suppressionand no severe complications were extended by cytarabine2-4days, andetoposide100mg/d,2-3days.(Bone marrow inhibition is defined as: the bonemarrow nucleated cells reducing or severely reducing and the original ratio <20%). The treatment after achieved complete remission as follows:with asustained remission, the intervals of chemotherapy, once a month in the firstyear, once every two months in the second year and every three months in thethird year.Chemotherapy regimen is agents combined with cytarabine such asetoposide, mitoxantrone and other drugs. If relapse, give relief treatmentagain.Analysis the influence of individualized chemotherapy for completeresponse rate, the recurrence rate and survival rate.Results:1The clinical situation:375patients,310cases (82.7%) less than65-year-old, male,163cases (52.6%), female,147cases (47.4%), not partingAML patients,7cases (2.3%), M0,2cases (0.6%),1case (0.3%), M1M2in147cases (47.5%), the M473cases (23.5%), the M5,68cases (22%), M610cases (3.2%), M7in2cases (0.6%).2Overall rate of CR and CR1:264cases (male136, female128)completed the first course of treatment.Approximately79.9%of adults withAML achieve complete remission (CR)(211cases),191cases achieveCR17(2.3%).3IA and DA: With264patients,154cases choose IA with125casesachieve CR(CR rate81.2%, CR1rate73.4%), PR7cases(4.5%)， NR22cases(14.3%)，92cases choose DA with74cases achieve CR(CR rate80.4%,CR1rate72.8%), PR3cases(3.3%)，NR15cases(16.3%). Another18cases of patients with MA, HA, TA, EA regimen,12patients achievedcomplete remission, the CR rate was66.7%, CR1rate was61.1%(11cases).The3-year relapse-free survival rate of the two groups were45.5%, 44.8%.4The CR rate in different groups:255cases of treatment with cytarabineplus anthracycline programs,"3+7" program in67cases (26.3%), CR49cases (73.1%),42patients (62.7%)of CR1, PR4cases (6%)，NR14cases(20.9%)，dose adjustment of the188cases (73.7%), prolonged treatment of112patients (43.9%),89cases CR in112cases (79.5%), CR182patients(73.2%), PR4cases(3.5%)，NR19case（s17%)，shorten the course of treatment,the CR69cases (90.8%), CR164patients (84.2%),PR2cases(2.6%)，NR5cases(6.6%).The3-year relapse-free survival rate of the three groups were45%,38%,50%.5After the first course, the residual original cell percentage of bonemarrow impact on CR:After the first course of chemotherapy,162cases ofpatients take bone marrow examination, the proportion of the the originalimmature bone marrow cells is less than5%of the total of65cases, CR56cases (86%), CR155(84.6%), CR21case (1.5%), PR3case (4.7%)，NR6case（9.3%)， the proportion of5%-10%of32cases, CR29cases (90.6%), CR125(78.1%), CR24cases (12.5%), PR2cases（6.3%），NR1cases (3.1%），theproportion of10%-20%of28cases, CR20cases (71.4%), CR116(57.1%),CR23cases (10.7%), PR1cases (3.6%)，NR7cases (25%)，the proportion of>20%of the total of37cases, CR27patients (73%), CR120patients (54%),CR27cases (19%), PR1cases (2.7%)，NR9cases (24.3%).Each group of3-year recurrence rates were44.6%,44.8%,55%,52%.6Genetic analysis:264cases treated in AML patients,17cases ofpatients with chromosome karyotype analysis,14cases of abnormal,15casesto adjust medication treatment, the CR rate was82%.66cases of M2of AML/ETO fusion gene testing, positive in24cases (36.4%), CR23cases (95.8%)and negative in42cases (63.6%), CR33cases (78.6%),29cases of M4ofCBFβ/MYH-11fusion gene was positive in10cases (34.5%), the CR9patients (90%), negative cases19(65.5%), CR17cases (89.5%).7Subsequent treatment: At the end of the follow-up to December2012,211cases in264patients achieved CR,20cases were lost,105cases relapse within three years, the1,2,3,5-year recurrence rates were32.5%、50.3%、55%、66%, long-term survival rates were71.7%、52.1%、44%、35%.837patients with infections (14%) on admission,pancytopenia periodafter chemotherapy appears to infection in211cases (80%),the site ofinfection, lung infection in35cases,7cases of perianal infection,4cases oforal infection,165cases with no obvious infection causing fever,37cases ofinfection by more than two parts, of which38cases with bacteriologicalculture of evidence, accounted for36.9%, most of sputum culture results.Eight cases due to severe infection is difficult to control, the family requestedautomatically discharged (3%).Conclusion: Monitoring of bone marrow individualized chemotherapy inthe treatment of the AML can obtain a higher complete remission rate and thefirst course of treatment remission rates, and reduce infection rates andmortality. After the first course of chemotherapy, bone marrow the CentralPlains immature cells of the proportion is less than10%of the patients withCR rate and CR1has improved significantly.