| Objective:To compare The efficacy between DA induction Regimen (daunorubicin+cytosine arabinoside) and IA induction regimen(idarubicin+cytosine arabinoside)in newly diagnosed patients of acute myeloid leukemia by retrospective analysis.Material and method:512newly diagnosed patients of AML (not include APL) between February2007and January2012who were enrolled in our hospital. The subtype were confirmed according to the FAB standard. Everyone have been had the bone marrow cell morphology and chromosome test, some of them also test the fusion gene and the gene mutation. The512patients were divided into two groups according to different regimens,193patients were treated with daunorubicin,319patients were treated with idarubicin. We compared count data with X2test, and calculated overall survival and progression-free survival by Kaplan-Meier survival curve, P<0.05has statistic significance. Results:1There were193patients treated with daunorubicin, after the first course of induction therapy, the complete remission is91(47.3%),the total complete remission is128(66.7%); There were193patients treated with idarubicin, after the first course of induction therapy, the complete remission is195(61.1%),the total complete remission is239(74.9%);the statistic analysis shows P=0.041and P=0.133, which means there is statistic significance in complete remission rate after first course of induction therapy between these two drugs,but no statistic significance in total complete remission rate.2Every patients has divided into different groups according to their chromosome karyotype. In the poor prognosis group, the total complete remission rate is19.6%,in the median or good prognosis group, the total complete remission rate is75.6%,they have statistic significance. Among them,DA group has27poor prognosis, total complete remission rate21.7%, IA group has36poor prognosis, total complete remission rate18.2%, they have no statistic significance(P=0.154); DA group has166median or good prognosis, total complete remission rate69.4%, IA group has283median or good prognosis, total complete remission rate79.1%,they have statistic significance (P=0.036).In the IA group, the median overall survival is25m(95%CI5.9.6～16.2m), In the DA group, the median overall survival is19m(95%CI13.0～49.7m), they have no statistic significance(P=0.448); In the IA group, the median progression-free survival is19m(95%CI16.9～25.1m), In the DA group, the median overall survival is15m(95%CI12.2～17.8m), they have no statistic significance.3In the poor prognosis group, the median OS of patients treated with IA regimen is9m(95%CI5.9～16.2m),the median OS of patients treated with DA regimen is9m(95%CI4.7～14.3m), they have no statistic significance (P=0.691); In the median prognosis group, the median OS of patients treated with IA regimen is27m(95%CI13.5～40.7m),the median PFS isl8m(95%CI16.1～19.9m), the median OS of patients treated with DA regimen is27m(95%CI14.0～41.2m), the median PFS is14m(95%CI 11.4～16.5m), they have no statistic significance in OS (P=0.996),but have statistic significance in PFS (P=0.045);and in the good prognosis group, the OS and the PFS also show no statistic significance between IA group and DA group.There were91elder patients (age>60y),57treated with idarubicin,34treated with daunorubicin, there is a trend that IA regimen have good OS than the DA regimen(P=0.052);but for the patients with high level white blood cell counts, IA regimen shows no statistic significance compared with DA regimen.Conclusion:for the newly diagnosed acute myeloid leukemia patients, an combination therapy based on Idarubicin has advantages on first-course CR rate compared with the regimen based on daunorubicin; and for the median-good prognosis patients,the total CR rate also show some advantage on Idarubicin; the cytogenetics feature、age、WBC count are some key factor which influence OS and PFS, for the median prognosis patients and old patients,we prefer Idarubicin because of its potential of prolong the PFS. |
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