Patients and methods
We retrospectively studied 307 newly diagnosed non-M3 AML patients at
our center over ten years from October 2005 to September 2015. The
follow-up period ranged from 1 to 176 months, with a median follow-up
time of 35 months. AML patients ≤15 years old were consecutively
enrolled, and acute promyelocytic leukemia patients were excluded. The
diagnosis and morphologic subtype of AML was based on the
French-American-British
(FAB) classification.13 All patients were classified
into two groups according to the WBC count at diagnosis: those without
hyperleukocytosis (WBC count <50×109/L
group) versus those with hyperleukocytosis (WBC count
≥50×109/L group).
Moreover,
patients in the hyperleukocytosis group were divided into two subgroups:
32 patients
with
WBC count 50-100×109/L and 49 with WBC count
≥100×109/L. Cytogenetic risk
category
accorded to
2017
European
leukemia net(ELN) .14
Chemotherapyregimen
All patient in this study received
Chinese
Academy of Medical Science (CAMS)-2009 regimen, referred to the AML99
program for chemotherapy.15 The standard induction
treatment regimen consisted of etoposide,150 mg/m2with a 2-hour infusion on days 1-5, 3 days of
idarubicin
,8 mg/m2 iv on days 6-8, and seven days of
cytarabine,
200 mg/m2 on days 6-12. A second course of induction
therapy was given if not achieved CR. The five courses of consolidation
treatment consisted of high-dose cytarabine combined with etoposide or
idarubicin.16 Patients with high risk or secondary
remission after recurrence
recommended
to receive allogeneic
hematopoietic
stem cell transplantation(HSCT). If there was no condition to perform
HSCT, consolidation and
strengthen
treatment
should be continued.
The
patients
received
prophylactic treatment for central nervous system through intrathecal
multi-drug chemotherapy at
once
per course of treatment.