以亚砷酸为主方案治疗急性早幼粒细胞白血病的分子生物学疗效

 目的　观察以亚砷酸为主的方案治疗初治的急性早幼粒细胞白血病（APL）的细胞学及分子生物学疗效。方法　56例APL患者均经骨髓细胞形态学检查、组织化学检查、免疫表型测定以及FISH法和实时定量PCR法检测PML／RARα融合基因而确诊。诱导化疗方案采用亚砷酸10 mg／d，静脉滴注，直至获得完全缓解。缓解后采用亚砷酸与化疗交替治疗，以亚砷酸为主。对20例患者的PML／RARα融合基因进行动态观察。结果　56例PML-RARα融合基因阳性的初治APL患者完全缓解率98.2 ％，CR中位时间32（23～42） d。实时定量RT-PCR检测阳性的32例患者中位随访期3年，总生存率100 ％，复发率3.12 ％。完全缓解24个月后分子生物学缓解率100 ％（6／6）。结论　以亚砷酸为主的方案治疗PML／RARα融合基因阳性的APL患者疗效好，血液学缓解后24个月有可能获得分子生物学缓解。

Study on molecular remission of acute promyelocytic leukemia treated with arsenic trioxide therapy

Objective　To evaluate the cytological and molecular remission of acute promyelocytic leukemia (APL) treated by Arsenic trioxide (ATO) therapyand observe the post-remission detection of PML/RARA fusion gene. Methods　56 patients were diagnosed as APL by bone marrow morphology, cytochem－istry, immunology, and confirmed by detection of PML/RARA gene using fluorescence in situ hybridization (FISH) and real-time PCR assay. Monitoring of minimal residual disease was performed regularly by Real-time PCR assay for PML/RARαat differential clinical stages. ATO was used at a dose of 10 mg once daily un－til the patients received complete remission (CR), as an induction therapy, and alternatively with chemotherapy as post-remission therapy. Results　The CR rate in 56 patients with PML/RARA positive APL was 98.2 %, the mean duration of CR was 32 days (23~42days). 32 patients were followed up for a mean duration of 3 years and the overall survival rate was 100 %, the relapse rate was 3.12 %. The molecular remission rate was 100 % in 6 patients detected 24 months after CR. Conclusion　ATO is an effective therapeutic agent in PML/RARA positive APL and complete molecular remission can be obtained 24 months after complete mor－phological remission by this therapy.