60 mg·m(−2)·d(−1)柔红霉素联合标准剂量阿糖胞苷诱导治疗≤65岁初治急性髓系白血病患者的疗效和安全性分析

OBJECTIVE: To evaluate the long-term safety and efficacy of high-dose daunorubicin (DNR) (60 mg·m(−2)·d(−1)) combined with standard dose of cytarabine (DA) as induction therapy in patients under 65 years old with newly diagnosed acute myeloid leukemia (AML). METHODS: The complete remission (CR) rate, disease free survival (DFS), overall survival (OS) and side effects of therapy were retrospectively assayed in 116 patients with newly diagnosed AML who were younger than 65 years old and received daunorubicin (60 mg · m(−2)·d(−1)) combined with cytarabine (Ara-C 200 mg ·m(−2)·d(−1)) as induction therapy at Peking Union Medical College Hospital during July 2012 to February 2016. RESULTS: Of 116 patients, 78 cases (67.2%) achieved CR after first course of induction treatment, 94(81.0%) achieved CR after two courses of induction, and early death occurred in only 3 patients (2.6%) during the first course of induction treatment. Only 1 patient had asymptomatic decreased ejection fraction after 6 months of induction treatment. Eighty nine patients received 1 to 4 courses of consolidation. With a median follow-up of 24(1–46) months, the median DFS was 25 months and median OS was not achieved yet. Cox regression multifactor analysis showed genetics risk groups was the only risk factor for DFS (HR=0.258, 95% CI 0.100–0.664, P=0.005), while genetics risk groups (HR=0.309, 95% CI 0.126–0.756, P=0.010) and whether patients received more than one cycle of high dose of Ara-C as consolidation therapy (HR= 0.370, 95% CI 0.179–0.765, P=0.007) were independent factors associated with OS. CONCLUSION: In young adults with AML, intensifying induction therapy with a high daily dose of daunorubicin (60 mg/m(2)) could improve the rate of complete remission without obvious side effects.