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目的观察MEA方案(米托蒽醌、足叶乙苷、阿糖胞苷)治疗初治、复发或难治急性白血病(AL)的临床疗效及毒副作用。方法33例急性白血病患者均采用MEA方案诱导治疗,其中急性髓细胞白血病(AML)16例,急性淋巴细胞白血病(ALL)15例,急性混合性白血病(AHL)2例;初治16例,复发6例,难治性11例。结果①疗效:33例患者中23例(70%)获得完全缓解(CR),4例(12%)获得部分缓解(PR),总有效率82%;AML患者CR率75%,PR率12.5%,总有效率87.5%;ALL患者CR率67%,PR率13%,总有效率80%;AHL患者CR率50%,PR率0,总有效率50%;初治患者CR率81%,PR率6%,总有效率88%;复发、难治患者CR率59%,PR率18%,总有效率77%。②化疗不良反应:化疗后骨髓抑制期,白细胞<1.0×109/L、中性粒细胞<0.5×109/L、血小板<20×109/L于化疗开始后出现的中位时间分别为第10、10、11天,中位持续时间分别为9、10、9 d。24例(73%)患者出现发热,其中5例(21%)血培养检出病原菌;1例(4%)发生结核复燃,3例患者于化疗及恢复期间死亡,其中2例死于败血症、弥漫性血管内凝血;1例死于颅内出血;化疗相关病死率为9%。③随访:随访时间165个月,中位随访时间7.5个月,中位持续CR时间7个月。结论MEA方案对于初治、复发及难治AL均可取得良好的诱导缓解疗效,但其骨髓抑制较重而持久,使用时应结合强力的对症支持治疗及血液学监测。
Objective To observe the clinical efficacy and side effects of MEA regimen (mitoxantrone, etoposide and cytarabine) in the treatment of newly diagnosed, relapsed or refractory acute leukemia (AL). Methods Thirty-three patients with acute leukemia were treated with MEA, including 16 cases of acute myeloid leukemia (AML), 15 cases of acute lymphoblastic leukemia (ALL) and 2 cases of acute mixed leukemia (AHL) 6 cases, refractory in 11 cases. Results ① Efficacy: 23 patients (70%) achieved complete remission (CR) in 33 patients and partial response (PR) in 4 patients (12%), with a total effective rate of 82%; CR rates of AML patients were 75% and PR rates were 12.5 %, The total effective rate was 87.5%; ALL patients with CR rate of 67%, PR rate of 13%, the total effective rate of 80%; AHL CR rate of 50%, PR rate of 0, the total effective rate of 50% , PR rate of 6%, the total effective rate of 88%; recurrence, refractory patients CR rate of 59%, PR rate of 18%, the total effective rate of 77%. ② Adverse reactions to chemotherapy: The median time of post-chemotherapy bone marrow suppression, white blood cell count <1.0 × 109 / L, neutrophil count <0.5 × 109 / L and platelet count <20 × 109 / L were 10 , 10,11 days, the median duration were 9,10,9 d. Of the 24 patients (73%) who developed fever, 5 (21%) of them developed pathogenic bacteria in their blood cultures; one patient (4%) developed a relapse of tuberculosis and 3 patients died during chemotherapy and recovery. Two of them died of sepsis , Diffuse intravascular coagulation; 1 patient died of intracranial hemorrhage; chemotherapy-related mortality was 9%. ③ Follow-up: The follow-up time was 165 months. The median follow-up time was 7.5 months. The median duration of CR was 7 months. Conclusions The MEA regimen can achieve a good induction and remission effect on initial treatment, relapse and refractory AL, but its myelosuppression is heavy and lasting, and should be combined with strong symptomatic supportive therapy and hematological monitoring.