国际指南更新带来血液肿瘤治疗新思考(克拉屈滨)教案分析.pptVIP

AML成功治疗取决于能否达到CR、能否预防复发，均受到诱导化疗疗效的影响 AML诱导治疗：年龄分界点为60岁。60岁，不良细胞遗传学特性和既往MDS更普遍，多药耐药发生率更高；并发症更多，影响患者对强烈治疗的耐受性。 60岁以下AML患者，诱导治疗的CR率极少超过70%；老年AML患者，CR率极少超过50%。CR率提高还有很大空间，需要开展大量临床研究。 NCCN指南对60岁以上、以下年龄段分别给出治疗推荐。 * 60岁以下AML患者诱导治疗，基本药物阿糖胞苷+一种蒽环类药物。DA“7+3”经典联合诱导方案，过去25年极少变化。AraC（100 mg/m2 CI）7天，DNR 45 mg/m2/d 3天。 药物剂量变迁：柔红霉素剂量：45-60 mg/m2→90 mg/m2 ×3天，或以伊达比星（IDA）替代：细胞内停留时间更长，12 mg/m2×3天，缓解率与DA方案相同。 金标准：DA 3-7方案 自1982年开始[1,2] 用另一种蒽环取代DNR或加用TG（硫鸟嘌呤）/依托泊苷，结果均无改善[3-9] 1. Yates J, Glidewell O, Wiernik P, et al: Cytosine arabinoside with daunorubicin or adriamycin therapy with acute myelocytic leukemia: A CALGB study. Blood 60:454-462, 1982 2. Do¨hner H, Estey EH, Amadori S, et al: Diagnosis and management of acute myeloid leukemia in adults: Recommendations from an international expert panel, on behalf of the European LeukemiaNet. Blood 115:453-474, 2010 3. Mandelli F, Vignetti M, Suciu S, et al: Daunorubicin versus mitoxantrone versus idarubicin as induction and consolidation chemotherapy for adults with acute myeloid leukemia: The EORTC and GIMEMA Groups Study AML-10. J Clin Oncol 27: 5397-5403, 2009 4. Arlin Z, Case DC Jr, Moore J, et al: Randomized multicenter trial of cytosine arabinoside with mitoxantrone or daunorubicin in previously untreated adult patients with acute nonlymphocytic leukemia (ANLL): Lederle Cooperative Group. Leukemia 4:177-183, 1990 5. Lo¨wenberg B, Suciu S, Archimbaud E, et al: Mitoxantrone versus daunorubicin in inductionconsolidation chemotherapy: The value of low-dose cytarabine for maintenance of remission, and an assessment of prognostic factors in acute myeloid leukemia in the elderly—Final report, European Organization for the Research and Treatment of Cancer and the Dutch-Belgian Hemato-Oncology Cooperative Hovon Group. J Clin Oncol 16:872-881, 1998 6. Vogler WR, Velez-Garcia E, Weiner RS, et al: A phase III trial comparing idarubicin and daunorubicin in combination with cytarabine in acute myelogenous leukemia: A Southeastern Ca