地西他滨在AML的治疗地位要点.pptxVIP

地西他滨在老年/难治/复发AML的治疗地位 方宁目录 地西他滨在难治复发AML治疗方案 Version 2.2013, 03/01/13 ? National Comprehensive Cancer Network, Inc. 2013, All rights reserved. The NCCN Guidelines and this illustration may not be reproduced in any form without the express written permission of NCCN . ? ? AML-12 hh Patients with blast counts 50,000/mcL are at risk for tumor lysis and organ dysfunction secondary to leukostasis. Measures to rapidly reduce the WBC count include apheresis or hydroxyurea. jj See Supportive Care (AML-C 1 of 2). fff There is a web-based scoring tool available to evaluate the probability of complete response and early death after intensive induction therapy in elderly patients with AML: /. Krug U, Rollig C, Koschmieder A, et al. Complete remission and early death after intensive chemotherapy in patients aged 60 years or older with acute myeloid leukaemia: a web-based application for prediction of outcomes. Lancet 2010;376:2000-2008. jjj Response may not be evident before 3-4 cycles of treatment with hypomethylating agents (5-azacytidine, decitabine). Similar delays in response are likely with novel agents on a clinical trial, but endpoints will be defined by the protocol. Note: All recommendations are category 2A unless otherwise indicated. Clinical Trials: NCCN believes that the best management of any cancer patient is in a clinical trial. Participation in clinical trials is especially encouraged. 2014年NCCN关于老年AML-诱导治疗 NCCN(2013、2014)关于年龄?60岁AML患者的诱导治疗建议 临床一般情况较好(PS?2)：(1)无预后不良细胞遗传学和分子标志(良好细胞遗传学和分子学标志)，无MDS病史、非治疗相关性AML 临床试验； 标准剂量AraC(100-200mg/m2/dx7d)+IDA12mg/m2 (优先)或DNR45-90mg/m2/dx3d或MTZ(12mg/m2/dx3d)的方案； 低强度治疗，如皮下注射小剂量AraC、5-azacytidine或地西他滨(IIB类)。(2014强调“更适合于老年患者，相对不适