老年急性髓系白血病小剂量MA与CAG方案诱导治疗疗效比较及预后影响因素分析

OBJECTIVE: To analyze the difference of efficacy and prognostic factors between MA and CAG induction chemotherapy in elderly acute myelogenous leukemia (AML) patients. METHODS: From April 2009 to September 2015, 103 consecutive hospitalized 60-plus-year-old AML patients were retrospectively analyzed. NPM1 positive FLT3-ITD negative accounted for 17 cases (16.7%). Sixty-five patients received MA regimen and thirty-eight patients received CAG regimen. MA group had higher WBC and FLT3-ITD positive mutations at diagnosis compared with CAG group (P=0.001, P=0.005; respectively). The median follow-up was 13 months for all patients and 17 months for the survivors. RESULTS: Six patient (5.8%) died in early phase. Complete remission (CR) rate after the first cycle of induction chemotherapy was 51.5% (50/97). Overall CR rate was 70.1% (68/97). CR rate after the first cycle of induction chemotherapy and overall CR rate were indiscriminate between MA and CAG regimen. The time to neutrophil count recovery, the time to platelet count recovery and the number of platelet transfusions were indiscriminate between MA and CAG regimen. Among 68 CR patients, 23 patients relapsed at median 9 months, and cumulative incidence of relapse (CIR) at 3 years was (52.5±10.1)%. Median overall survival (OS) was 20 months. OS rate at 3 years was 32.2%. Median disease-free survival (DFS) was 28 months. DFS rate at 3 years was 43.7%. CIR, DFS and OS at 3 years were indiscriminate between MA and CAG regimen. Multivariate analysis showed that less than 70 years of age (P=0.001), achieved CR (P<0.001), and NPM1 (+) FLT3-ITD(−)mutation (P=0.044) were the independent factors for increasing OS. NPM1(+) FLT3-ITD(−)mutation was the independent factor for increasing DFS (P=0.042). Patients were classified by three prognosis factors: <70 ages, CR, and NPM1(+)FLT3-ITD(−)mutation. Patients with no poor prognosis factors were classified as low risk (n=13), with one factor as medium risk (n=52) and with two and more factors as high risk (n=31). There were significant differences in OS rate and DFS rate at 3 years for 3 groups patients (60.5% vs 48.1% vs 0, P<0.001; 60.2% vs 39.4% vs 0, P=0.045; respectively). OS and DFS at 3 years for 3 groups' patients were indiscriminate between MA and CAG regimen. CONCLUSION: There was indiscrimination of efficacy among MA and CAG induction chemotherapy in old AML patients. Less than 70 years of age, CR and NPM1(+)FLT3-ITD(−) mutation were the independent factors for better survival.