Analysis Of Clinical Efficacy And Safety Of Three Different Treatments For Refractory/relapsed Acute Myeloid Leukemia

Objective:To investigate the clinical efficacy and safety of HAA,CAG and DCAG therapeutic regimens for refractory/relapsed Acute Myeloid Leukemia(R/R-AML),so as to provide more clinical evidence for the choice of chemotherapy scheme in patients with refractory or relapsed AML.Methods:The clinical data of 67 patients with relapsed and refractory AML admitted to the inpatient of our hospital from January 2013 to January 2018 were collected.There were 33 males and 34 females,aged 24-69 years,with a median age of 46.(32-64)years old.All patients were diagnosed as AML(non-M3)by morphology,cytogenetics,immunology,and molecular biology(MICM).(1)Patients were divided into three groups according to different chemotherapy regimens,of which 22 were in the HAA group(homoblastic acid base + cytarabine + aclamycin);the CAG group(cytarabine + aracycline + granules)17 cases of cell colony stimulating factor;28 cases of DCAG group(decitabine + cytarabine + aclamycin + granulocyte colony stimulating factor).The complete response rate(Complete Remission,CR)And Overall Response(ORR)and compare the differences between the groups by statistical analysis.(2)Divided into different subgroups according to the number of bone marrow blasts before treatment,age,gender,and number of white blood cells,platelets,and hemoglobin before treatment.Statistically analyze the differences in ORR of the three groups to evaluate the treatment effect of each group and analyze the effect Factors and occurrence of treatment-related adverse reactions were evaluated to evaluate the safety of treatment options in each group.Results:1.The CR of HAA group,CAG group,and DCAG group after a course of treatment were 27.27%,41.18%,and 57.14%,respectively,with no significant difference(P = 0.104);ORR among the three groups was 36.36% and 52.94%,respectively.,82.14%,significant difference(P = 0.004),further comparisons between groups: ORA in HAA group and CAG group were not significantly different(P = 0.301),and there was no statistical difference in ORR between CAG group and DCAG group(P = 0.036> 0.0167);however,the ORR in the DCAG group was significantly higher than that in the HAA group(X2 = 10.959,P = 0.001).1.Subgroup analysis: There was no statistically significant difference in ORR between the three groups with age and gender as the basis for stratification;with blood image as the basis for stratification,white blood cells were <4 × 10 ^ 9 / L,white blood cells were ?4 × 10 ^ 9 / L,white blood cells <10 × 10 ^ 9 / L,white blood cells ?10 × 10 ^ 9 / L,platelets <20 × 10 ^ 9 / L,hemoglobin ?60g / L.There was no significant difference in the levels;hemoglobin <60g / There were 18 cases of L.The ORRs in the HAA,CAG,and DCAG groups were 0%,0%,and 75%,respectively.There was a significant difference in ORR between the three groups(P = 0.001).A further pairwise comparison was performed.The difference(P = 1.000),the ORR of DCAG group was significantly higher than that of HAA and CAG group(P = 0.005);there were 53 patients with platelet ?20 × 10 ^ 9 / L,and the ORR of HAA,CAG and DCAG groups were 37.50% ?53.84%?87.5%,ORR was significantly different between the three groups(P = 0.003).There was no significant difference in ORR between the HAA group and the CAG group(P = 0.301),and there was no significant difference in the ORR between the CAG and DCAG groups(P = 0.032),the ORR of DCAG group was significantly higher than that of HAA group(P = 0.001).The stratification was based on the number of primordial cells before treatment.There was no significant difference in ORR between the three groups.There were 34 cases of primitive cells with ?30%.The ORRs in the HAA,CAG,and DCAG groups were 33.33%,50%,and 90.90%,respectively.There was a statistically significant difference in ORR between the three groups(P = 0.017).Comparison was made in pairs: There was no significant difference in ORR in CAG group(P = 0.657),there was no significant difference in ORR in CAG group and DCAG group(P = 0.111),and ORR in DCAG group was higher than HAA group(P = 0.005).2.Comparative analysis of the use of blood products,the median amount of red blood cells transfused in the HAA group was 1U(0,6U),the median amount of platelet transfused apheresis 2U(1,3U);the median amount of red blood cells transfused in the CAG group was 1U(0,5.5U),the median apheresis platelet volume was 2U(1,5U);the DCAG group had a median red blood cell volume of 2.75U(0,8.75U),and the median apheresis platelet volume was 2U(2,5U);three There were no significant differences in the amount of leukocyte-removed suspended red blood cells and the number of platelets collected in the group(P> 0.05).The median hospital stays in the HAA,CAG,and DCAG groups were 24 days(22,29.75 days),24 days(22,30.5 days),and 27 days(22.25,30 days).There was no significant difference in the average hospital stay days.(P = 0.638).4.Comparison of adverse reactions of the three groups: HAA group,CAG group,and DCAG group were the most common adverse reactions after infection,grade III ~ IV bone marrow suppression,gastrointestinal symptoms,bleeding,and liver damage.HAA,CAG,The incidences of infection in the DCAG group were 90.91%,52.94%,and 92.86%,respectively.The differences in the infections of the three groups were statistically significant(P = 0.003).Comparison among the two groups: There was no significant difference in the incidences of infection in the HAA group and the DCAG group(P = 1)There was a statistically significant difference in the incidence of infection between the HAA group and the CAG group(P = 0.011),and the incidence of infection in the DCAG group was also higher than that in the CAG group(P = 0.003).The incidence of grade I ~ II infections: The incidences in the HAA,CAG,and DCAG groups were 54.54%,17.65%,and 53.57%,respectively,and the differences were statistically significant(P = 0.023).A pairwise comparison was performed in the further group: there was no significant difference between the HAA group and the DCAG group(P = 1),there was no significant difference between the HAA group and the CAG group(P = 0.024),and the incidence of grade I ~ II infection in the DCAG group Higher than group CAG(P = 0.013),but the incidence of grade III to IV infection was not statistically significant(P = 1).There were no significant differences in the incidence of hematological adverse reactions,nausea,vomiting,diarrhea,bleeding,liver damage and other side effects among the three groups.A total of 4 patients died during treatment in the three groups,2 in the HAA group,1 in the CAG group,and 1 in the DCAG group.Conclusion: Compared with HAA and CAG regimen,DCAG regimen is more effective and does not increase severe chemotherapy-related toxic and side effects.Therefore,it is one of the ideal protocols for the treatment of recurrent refractory AML.