8李军民老年AML2重点.pptVIP

The treatment of relapsed and refractory AML in older patients Treatment Decision in Elderly AML (R/R) Leukemia Research 39 (2015) 124–130 谢谢 * 在最近发表的协作研究中，Lowenberg等报道了在813名初次治疗的60岁以上AML患者中，使用45mg/m2或90mg/m2的柔红霉素（DNR）进行诱导治疗的比较结果。虽然使用更高剂量DNR进行诱导的患者CR率得到了改善（64% vs 54%，P=0.002），但是两组患者的总生存（OS）及无事件生存（EFS）在两组间无明显差异。两组30天死亡率均为11-12%。法国协作组在ALFA-9801的研究中并没有证实相似的结果。他们的研究在50至70岁患者中，对80mg/m2/天的DNR与标准及大剂量去甲氧柔红霉素（IDA）进行诱导治疗进行比较。在该群患者中，高剂量的DNR及高剂量IDA并未获得比标准剂量IDA更高的临床相关优势。 * ALFA9803试验比较6个月的低剂量巩固治疗和1个循环的大剂量巩固治疗，长疗程巩固治疗获得了更高的OS（56% vs 37%）及DFS（28% vs 17%）。 AML HD98研究，在获得CR的患者中，在进行一次巩固治疗后随机分组，使用第二次大剂量的IDA/依托泊苷进行巩固，或者采用同样药物进行小剂量维持，强烈治疗组复发率较低，且生存改善（中位生存时间22.3个月 vs 14.3个月）。该研究同时提示多次使用该方案较单次使用该方案有优势，进一步支持使用大剂量巩固方案。在EROTC-GIMEMA的AML13试验中，缓解后治疗随机分为2次强烈静脉化疗及口服治疗，未证实2组间DFS具有差异。口服治疗组中位DFS为9个月，而静脉化疗组为10.4个月，3年DFS为13 vs 21%（P=0.15）。 Acta Haematol 2015;133:300–309 Age on Treatment Decision-Making Treatment Decision in Elderly AML (Newly) Leuk Lymphoma. 2014 Nov 3:1-7. Leuk Lymphoma. 2014 Nov 3:1-7. Treatment Decision in Elderly AML (Newly) Treatment Decision in Elderly AML (Newly) Treatment Decision in Elderly AML (Newly) Cancer Med. 2014 Dec;3(6):1570-8. Cancer Med. 2014 Dec;3(6):1570-8. Treatment Decision in Elderly AML (Newly) Oncotarget. 2015 Mar 20;6(8):6448-58. Treatment Decision in Elderly AML (Newly) The optimal combination therapy for the treatment of newly diagnosed AML in older patients Optimal combination therapy for AML in older patients Induction therapy was a combination of Ara-C (100 mg/m2/d as continuous intravenous infusion on days 1-7) and daunorubicin (60 mg/m2/d intravenously on days 1-3). Patients not in complete remission (CR) after one induction cycle could receive a second identical cycle. Patients in CR were consolidated with three cycles of intermediate-dose Ara-C (1g/m2 twice daily on days 1, 3 and 5). Sunitinib was added to this regimen in a phase I design. Patients in dose level 1 received sunitinib 25 mg/d continuously. If