The Clinical Efficacy And Safety On Patients With AML And MDS-RAEB Treated By CAG Regimen

Purpose This study aims to assessing the clinical effectiveness and safety of CAG regimen in acute myelogenous leukemia(AML)and myelodysplastic syndrome-refractory anemia with excess blasts(MDS-RAEB).Methods In this study,acute myeloid leukemia and myelodysplastic syndrome-refractory anemia with excess blasts in first hospital of Lanzhou university from January 2008 to July 2017 were collected and a total of 131 patients treated with CAG regimen were enrolled.All patients were cured with CAG regimen.The complete remission(CR)rate and overall response(OR)rate of patient after CAG regimen are evaluated and the different of CR and OR rate between disease types,age,disease condition and karyotype are compared.The adverse reaction of chemotherapy is observed and its severity assessed.In addition,the regimen of CAG,IA(E),DA(E)HA and medium/large dose of Ara-c was used to consolidate treatment for 6-8 courses after remission,and long-term follow-up was conducted for the total survival of patients.Results1.Clinical features: Among the 131 patients,66 are male and 37 are female,and the median age was 53(6~82)years old.There were 103 cases of AML patients,including 73 cases of primary and 30 cases of recurrence/refractory,5 cases of MDS-AML,and 23 cases of MDS-RAEB.2.Curative effect: There are 103 patients with AML and 73 cases of which are primary and 30 cases are recurrence/refractory.The CR and OR rate are 56.2%,64.4% and 53.3%,63.3% respectively.There is no significant difference between CR and OR rate in primary and recurrence/refractory AML.39 patients are aged ? 60,and the CR and OR rate are 53.8% and 64.1% respectively.The CR and OR rate are 56.5% and 63.8% of 69 patients aged < 60 years old.There was also no significant difference in CR and OR rates between aged ? 60 and < 60 years old(p>0.05).In addition,among the 103 patients with AML,The CR rate is lower in patients with AML-M4/AML-M5 than other types,but the difference has not statistically significant(p>0.05).There are 23 patients with MDS-RAEB 21 cases of which are primary and 2 cases are recurrence/refractory.In the primary patients,the CR and OR rates are 47.6% and 61.9% respectively.Patients with recurrence/ refractory had no remission.Among the 76 patients with chromosomal examination,the CR and the OR rate of the patients with good and moderate prognosis is significantly higher than those with poor prognosis,and the difference has statistically significant(p<0.05).2.Adverse reactions: The main adverse reaction of hematology is bone marrow suppression.There are 65(49.6%)patients with III-IV bone marrow suppression.According to the WHO toxicity criteria,46(35.1%)patients were infected.A few patients have mild gastrointestinal reactions and slight damage of liver and kidney,.Only 5(3.8%)patients died during the treatment.3.Prognosis and follow-up: Among the 131 patients,28 patients lost visit,the median total survival was 15(0~96)months.The OS rate of AML patients is significantly higher than that in MDS-RAEB patients,and the difference have statistically significant(p<0.05).Conclusions 1.The CAG regimen has good efficacy for patients with primary,recurrence/refractory AML and MDS-RAEB,and there was no significant difference in CR and OR rate between age ? 60 and < 60 years old,suggesting that the elderly patients could be tolerated.2.There is no significant difference between the CR and OR rate in primary and refractory/recurrence AML patients,considering that the CAG regimen may be overcomes cell resistance.3.The CR rate of patients with AML-M4/AML-M5 is lower than that of other AML patients.4.The CR and OR rates of patients with poor and moderate prognosis are significantly higher than those with poor prognosis of chromosome karyotypes.5.The CAG regimen has low toxicity and good tolerance,the non-hematologic adverse reactions mild,cardiac toxicity and early mortality is low.