全反式维甲酸三氧化二砷联合化疗治疗儿童急性早幼粒白血病的疗效分析

目的评价全反式维甲酸(ATRA)、三氧化二砷(As2O3)的联合化疗治疗方案对儿童急性早幼粒细胞性白血病(APL)的疗效。方法1995-07—2005-06在中山大学附属二院及广州市儿童医院共有14例患儿接受了含ATRA、As2O3的联合化疗方案，其中男10例，女4例；年龄2.1~12岁，平均6.7岁。所有病例起病时均有贫血、皮肤瘀斑或牙龈出血等表现；骨髓检查原始＋幼稚细胞比例为59.0%~97.5%，其中M3a 9例，M3b 5例；8例患儿行PML-RARα融合基因检测，其中阳性6例。比较不同细胞学类型、化疗方案等对APL的疗效及对复发率的影响。结果14例中有12例(85.71%)使用上述的诱导缓解方案达到骨髓(BM)缓解CR1，由开始治疗到BM CR1的中位时间为5周(2~9周)；该组病例使用As2O3、DA、HA、EA、DEA序贯或同时联合其它化疗的巩固方案，共2例复发，均为M3b；用不同的巩固方案对APL复发影响差异无显著性(P=0.195)；含As2O3的方案进行维持治疗可能减少APL患儿的复发；是否加用VP/6MP+MTX序贯维持治疗对控制复发差异无显著性(P=0.66)。结论含ATRA、As2O3的联合化疗方案对儿童APL是一种有效的治疗方法，可以减少复发。

Effect of all-trans retinoic acid combined with arsenic trioxide in chemotherapy on childhood acute promyelocytic leukemia.

AbstractObjective To evaluate effect of all-trans retinoic acid combined with arsenic trioxide in chemotherapy on childhood acute promyelocytic leukemia (APL).MethodsRetrospective analyses was done on the data of 14 cases of childhood APL who received combined treatment of all-trans retinoic acid with arsenic trioxide in the chemotherapy between 1999 and 2005:ten boys and four girls aged from 2.1 to 12 years old,mean age 6.7 years old.All the children had anaemia,skin ecchymosis or gum bleeding on onset.The percentage of blast plus juvenile cell in diagnostic bone marrow ranged from 59%to 97.5%, mean 80.71%±10.96%.There are nine cases of M3a and five cases of M3b according to FAB classification.PML-RAR alpha fusion gene at diagnosis was performed in eight patients,positive in six cases(75%).The effects of different therapeutic regimens or these regimens on various FAB grouping and relapse rate were analyzed.ResultsTwelve of the 14 patients (85.71%) achieved CR1 after the induction therapy.The median of CR1 was five weeks (ranged from two to nine weeks).The consolidation therapy consisted of arsenic trioxide,DA,HA,EA and DEA regimens or combined with other chemotherapies;two M3b patients relapsed.There were no differences for relapse rate among various strategies of consolidation (P=0.195);maintenance therapy consisting of arsenic trioxide may decrease the relapse rate.There was no significant difference for relapse rate with or without VP/6MP and MTX in the maintenance therapy (P=0.66).ConclusionCombined all-trans retinoic acid with arsenic trioxide in the chemotherapy is efficient treatment on childhood APL and can decraese relapse.