IA和HAD方案诱导治疗成人初诊急性髓系白血病的疗效比较

OBJECTIVE: To compare the efficacy of two induction regimens, namely, idarubicin combined with cytarabine（IA）versus the combination of homoharringtonine, daunorubicin, and cytarabine（HAD）, in adult patients with newly diagnosed de novo acute myeloid leukemia（AML）. METHODS: From May 2014 to November 2019, 199 patients diagnosed with AML receiving either the IA or HAD regimens were assessed for overall survival（OS）, relapse-free survival（RFS）, as well as the CR rate and the MRD negative rate after induction therapy. The differences in prognosis between the two induction therapy groups was assessed according to factors, including age, white blood cell（WBC）count, NPM1 mutation, FLT3-ITD mutation, 2017 ELN risk stratification, CR(1) transplantation, and the use of high-dose cytarabine during consolidation therapy, etc. RESULTS: Among the 199 patients, there were 104 males and 95 females, with a median age of 37（15–61）years. Ninety patients received the IA regimen, and 109 received the HAD regimen. Comparing the efficacy of the IA and HAD regimens, the CR rates after the first induction therapy were 71.1％ and 63.3％, respectively（P＝0.245）, and the MRD negative rates after the first induction therapy were 53.3％ and 48.6％, respectively（P＝0.509）. One patient in the IA group and two in the HAD group died within 60 days after induction. The two-year OS was 61.5％ and 70.6％, respectively（P＝0.835）, and the two-year RFS was 51.6％ and 57.8％, respectively（P＝0.291）. There were no statistically significant differences between the two groups. Multivariate analysis showed that the ELN risk stratification was an independent risk factor in both induction groups; CR(1) HSCT was an independent prognostic factor for OS and RFS in the IA patients and for RFS in the HAD patients but not for OS in the HAD patients. Age, WBC level, NPM1 mutation, and FLT3-ITD mutation had no independent prognostic significance. CONCLUSION: The IA and HAD regimens were both effective induction regimens for AML patients.