| Objective:Estimate the efficacy and prognostic of acute myeloid leukemia (AML) treated by TCM combined chemotherapy, to explore the relationship between curative and prognostic factors, provides objective basis for improve short-term effects and long-term effects of TCM combined western medicine treatment of AML.Methods:Collected the clinical data of 69 patients with primary AML(acute promyelocytic leukemia excluded)onset of treatment in Xiyuan Hospital of China Academy of Chinese Medical Sciences from January 1997 to July 2013, through retrospective analysis their age, gender and related laboratory results to evaluate the efficacy of traditional Chinese medicine (TCM) combined chemotherapy. Telephone follow-up of patients and analysis of survival and age, chemotherapy regimens, risk assessed based on cytogenetic prognosis, the WBC count before treatment and the course of treatment to reach complete remission (CR). Using the SPSS20.0 statistical software for data analysis, we defined that P<0.05 have statistical significance.Results:(1) There are 56 patients (81.2%) got CR in 69 patients treatment with TCM combined chemotherapy. The median survival time of all CR patients was 4.11 years.and the average survival time was (8.7±1.3) years.The Disease-free survival(DFS) rate of 3 years in all the patients was(41±7)%.and the Overall survival(OS) rate was(43±7)%.(2) The age equal or greater than 60 years and less than 60 years patients with CR rate were 66.7% and 88.9%, the average OS time respectively were (9.2±1.5) years and (2.7 ±0.9) years,the DFS and OS rate of 3 years respectively were (26.0±9.5)%, (55.2± 8.6)% and (33.3±10.3)%, (59.1±8.4)%.(3) The patients’WBC count before treatmentequal or greater than30×109/L and less than 30×109/L with CR rate respectively were 77.8% and 82.4%, the average OS time respectively were (2.4±0.9) years and (8.7±1.3) years, the DFS and OS rate of 3 years respectively were (33.3±11.1)%, (51.6±7.7)% and (22.2±11.1)%, (59.9±7.5)%.(4) The CR rate of DA plan and other treatment respectively were 90% and 74.4%,the average OS time respectively were (10.9±1.7) years and (3.1±0.7) years, the DFS and OS rate of 3 years respectively were (68.1±9.0)%, (29.0±8.2)% and (63.1±10.0)%, (40.2 ±8.6)%.(5) The average OS time of treatment less than or equal to 1 cycle,2～3 course and more than 4 course of intermediate-dose cytarabine after patients got CR respectively were (6.5± 1.5) years, (5.7±1.1) years and (5.4±0.5) years, the DFS and OS rate of 3 years respectively were (49.4±9.7)%, (65.6±14.0)%, (85.7±13.2)% and (41.3±9.7)%, (55.6±14.9)%, (85.7±13.2)%。(6) The average OS time of treatment course got CR(1,2,≥3)respectively were (13.1± 1.6) years, (3.2±0.8) years and (1±0.5) years, the DFS and OS rate of 3 years of 1 course got CR and 2 course got CR respectively were (72.7±9)%,(31±11.1)% and (75.6±8.7)%, (44.8±12.1)%,while the DFS and OS rate of 3 years of equal or more than 3 course got CR was 0.(7) The CR rate of low risk cytogenetics, moderate risk cytogenetics and high risk cytogenetics patients respectively were 80%,77.3% and 85.7%,the DFS and OS rate of 3 years respectively were (66.7±27.2)%, (42.9±8.2)%, (42.9±18.7)% and (66.7±27.2)%, (50.6±8.1)%, (42.9±18.7)%.(8) The CR rate of different TCM diagnosis(Yuxuetanhe, Reduruxue, Reduchisheng, Qixueliangxu) respectivelywere 75%,100%,83.3%and 78.1%, The average OS time respectively were (4.5±1.5) years, (3.6±1.0) years, (6.8±1.4) years and (6.4±1.7) years, the DFS and OS rate of 3 years respectively were (50.0±17.7)%, (25.0±21.7)%, (53.5±13.1)%, (42.9±11.4)% and (43.8±18.8)%, (50.0±25.0)%, (59.7±13.0)%, (49.1±10.1)%.(9) The COX regression model analysis showed that the age was equal or greater than 60 years old, the count of WBC before treatment equal or greater than 30×109/L and the treatment course got CR more than 1 cycle when got CR, the relative risk(RR) respectively was 2.3 times,2.8 times and 3 times to overall survival(OS).Also, the count of WBC before treatment equal or greater than 30 X 109/L and the treatment course got CR more than 1 cycle whose relative risks(RR) was 2.7 times and 2.2 times to DFS.Conclusions:TCM combined with chemotherapy can improve the Disease-free survival(DFS) rate and the Overall survival(OS) rate of AML and prolong the survival time; the age which was equal or greater than 60 years old,the WBC count before treatment which was equal or greater than 30×109/L and the treatment course of complete remission (CR) which was equal or greater than 2 were the independent factors of unfavourable prognosis. |
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