Comparison Of Adjusted-dose DA And IA Regimen In Treatment Of Newly Diagnosed Acute Myeloid Leukemia In Adults

Leukemia is a series of hematopoietic malignancies originating from hematopoietic stem and progenitor cells,in whichacute myeloid leukemia?AML?is the most common type^[1].Over the past 30 years,the so-called regimen"3+7"comprising 7 days of cytosine arabinoside?100 to 200 mg/m2/d as continuous intravenous infusion?and 3days of daunorubicin?45 mg/m2/d?has been a standard induction therapy for AML.Many studies have shown that the compleate remission?CR?rate of AML patients using standard dose"3+7"regimen reach 60%^[2].At present,the most widely used anthracyclines are daunorubicin?DNR?and idarubicin?IDA?.There have been many comparative studies on the induction of AML between these two chemotherapeutic drugs at home and abroad.However,the the optimal dose of two chemotherapeutic drugs are still uncertain.Objective:To investigate the clinical efficacy and adverse reactions of dose-adjusted DA regimen and IA regimen in adult patients with newly diagnosed AML.Methods:Retrospectively analyze the clinical data of 97 adult patients with de novo AML which were diagnosed from September 2014 to September 2017 in Sichuan Provincial People's Hospital.Forty-one of them received DA regimen?DNR 60 mg/m2/d,d1-3;Ara-C 150 mg/m2/d,d1-7?and 56 cases received IA regimen?IDA 10mg/m2/d,d1-3;Ara-C 150 mg/m2/d,d1-7?.The clinical efficacy of the two groups was compared.The relapse rate,relapse-free survival time,and adverse drug reactions were analyzed and compared between the two groups as well.Results:In group DA and IA,the rate of CR for 1 courses was 53.7%?22/41?vs53.6%?30/56?.The comparison between two groups showed that the CR rate of DA group and IA group had no statistical significance?P=0.993?.The CR rate for 2 courses of DA and IA groups was 63.7%?26/41?vs 66.1%?37/56?respectively.The comparison between two groups had no statistical significance?P=0.786?.In the good prognosis group,the CR rate of group DA and group IA were 100%;In the middle risk group,the CR rate of group DA and group IA was 66.7%?8/12?vs 81.3%?13/16?,there were no differences between the two groups?P=0.378?.In the high risk group,the CR rate of two group was47.6%?10/21?vs 48.4%?15/31?,there were no differences between the two groups.?P=0.957?.In the hyperleukocytosis group,DA scheme and IA scheme of CR group were 66.7%?4/6?vs80%?4/5?,comparison between groups showed that DA group and IA group CR was not significant?P=0.621?.In the non-hyperleukocytosis group,DA scheme and IA scheme of CR group were 62.9%?22/35?vs 64.7%?26/51?,comparison between groups DA group and IA group's CR rate of two groups had no statistically significant?P=0.861?.Main side effects were myelosuppression,infection,cardiac toxicity,liver toxicity,no significant difference.Severe myelosuppression occurred in both groups,non-hematological adverse reactions included infection,cardiotoxicity,abnormal liver function,etc.Among them,theperianal infectionof DA and IA group were 19.6%vs 4.9%,statistically significant?P=0.035?.Other adverse reactions showed no significant difference between the two groups?P>0.05?.There was no early death in patients who received both chemotherapy protocols.Conclusion:There is no significant difference in the clinical efficacy and safety between the two protocols in the induction treatment of newly diagnosed adult AML patients.