Efficacy And Adverse Reactions Of Standard Dose And Reduced Dose Individualized Treatment Of Elderly Patients With Acute Myeloid Leukemia

Objective The induced remission rate,safety and long-term prognosis of the newly diagnosed acute myeloid leukemia(AML)were compared between the reduced-dose long-course regimen(CAG regimen)and the standard-dose regimen(DA regimen).Method Retrospective analysis of the newly diagnosed elderly(age?60 years)AML(non-M3)patients admitted to the Inner Mongolia Medical University Hospital from March 2013 to March 2018,according to the dose of anthracycline and the length of chemotherapy.Divided into the long-dose group and the standard dose group,and according to the patient's genetic and molecular biological data,the patients were divided into low-risk group,intermediate-risk group and high-risk group.After 2 courses of treatment,the clinical efficacy and adverse reactions of the two groups of patients were compared and analyzed.Results 1.A total of 33 patients in the long-dose group,17 patients achieved complete remission(CR),7 patients achieved partial remission(PR),CR rate was51.52%,the total effective rate was 72.73%,and the low-risk group CR rate was 80%.The CR rate of the medium-risk group was 61.11%,and the CR rate of the high-risk group was 30%.There were 27 patients in the standard dose group,16 patients had CR,5 patients had PR,CR rate was 59.26%,and the total effective rate was 77.78%.Among them,the low-risk group had a CR rate of 75%,the middle-risk group had a CR rate of 71.43%,and the high-risk group had a CR rate.33.33%.The efficacy of the compared dose-reduction regimen and the standard-dose regimen in the treatment of elderly patients with AML was not statistically significant(P>0.05),and the two groups were in different prognostic stratification based on cytogenetics and molecular biology.There is also no statistical difference in CR rate comparison.Early death in both groups(within 3 months)was 1 case.2.Myelosuppression was the main hematologic adverse reaction after chemotherapy in the two groups.The standard dose group had stronger inhibition of white blood cells,and the difference was statistically significant(P=0.03).There was no significant difference between the two groups in the inhibition of hemoglobin and platelets.(P>0.05).The non-hematologic adverse reactions of the two regimens mainly included pulmonary infection,gastrointestinal reactions and hemorrhage.The incidence of pulmonary infection in the standard dose group(81.48%)was higher than that in the reduced dose group(54.55%),and the difference was statistically significant.Significance(P=0.03),the other two groups of non-hematologic adverse reactions were not statistically significant(P>0.05).The overall median follow-up time was 17.5(1-68)months,the median survival time was 23 months,the 1-year OS rate was 78.2%,the 2-year OS rate was 49%,and the 3-year OS rate was 35.6%.Factors affecting the prognosis of patients with AML such as gender,number of newly diagnosed white blood cells,prognostic risk stratification,chemotherapy regimen,and single factor analysis on prognosis,the results showed that the OS of patients with newly diagnosed WBC?50×10~9/L was significantly lower than the control.In the group(P=0.018),OS in the high-risk group with genetic prognosis risk stratification was significantly lower than in the intermediate-risk group(P=0.001),while other factors had no statistically significant effect on OS.Multivariate analysis showed that the number of newly diagnosed white blood cells and prognostic risk stratification were independent prognostic factors affecting OS in elderly patients with AML.Conclusion 1.The dose-reduction long-term regimen was not worse than the standard dose regimen in the initial treatment of elderly patients with AML.There was no statistical difference between the two groups.2.The dose-reducing long-term regimen was significantly lower than the standard dose regimen after chemotherapy.The incidence of non-hematologic adverse reactions such as lung infection was also significantly lower than the standard dose regimen.There was no significant difference in long-term prognosis between the long-dose regimen and the standard-dose regimen.The independent prognostic factors affecting OS in elderly patients with AML were the number of newly diagnosed white blood cells and prognostic risk stratification.