亚砷酸治疗老年恶性血液病的初步观察

目的探讨亚砷酸治疗老年恶性血液病的临床疗效及不良反应。方法对40例≥60岁的恶性血液病患者,应用亚砷酸治疗(10mg/d,静脉滴注,28d为1疗程,如不良反应明显则改为14d短疗程,间隔14d后再用14d,2次为1疗程)。观察其临床疗效及不良反应。结果急性早幼粒细胞白血病(APL)完全缓解(CR)8例,其他急性非淋巴细胞白血病(ANLL)CR1例,部分缓解(PR)1例,未缓解(NR)6例;慢性粒细胞白血病(CML)PR4例,NR2例;慢性淋巴细胞白血病(CLL)CR1例,PR1例;B细胞非霍奇金淋巴瘤(NHL)CR1例,PR2例,进步1例,无效1例;骨髓增生异常综合征(MDS)PR2例,进步2例,无效1例;慢性粒单细胞白血病(CMML)CR2例,PR2例;多发性骨髓瘤(MM)PR1例,进步1例。所有病例总有效率为75%。仅2例因严重肝损害、骨髓抑制而停药,无用亚砷酸相关死亡病例。结论对不能耐受强化疗的老年难治、复发的血液肿瘤患者,亚砷酸具有一定的治疗效果,且不良反应相对较低。

Effects of arsenic trioxide on hematology malignancy in elderly patients

Objective To evaluate the therapeutic effects and adverse effects of arsenic trioxide on elderly patients with malignant hematology. Methods Forty elderly patients aged over 60 with hematology malignancy were enrolled in the present study. Arsenic trioxide was given by intravenous perfusion for 28 d. The patients who could not tolerate 28-day regimen due to drug toxicity received the same dose of arsenic trioxide for 14 d, undergoing a 14-day break to recover, and then completing the rest of the regimen in another 14 d. Therapeutic effects and toxicity of arsenic trioxide were observed throughout the entire clinical period. Results The overall effective rate for the cases enrolled was 78%. All of the 8 patients with acute promyelocytic leukemia(APL) achieved complete remission (CR). Among the 8 patients with acute non-lymphocytic leukemia(ANLL) with non-APL , 1 case achieved CR and 1 achieved partial remission(PR),whereas the rest of them achieved no remission(NR). Among the 6 patients with chronic myelocytic leukemia(CML), 4 achieved PR and 2 had no changes. One patient with chronic lymphocytic leukemia(CLL)achieved CR, and the other one achieved PR. Among the 5 patients with B cell non-Hodgkin's lymphoma(NHL), 1 achieved CR, 2 achieving PR,1 showing improvement,and 1 remaining unchanged. Among the 5 patients with myelodysplastic syndrome(MDS), 2 patients achieved PR,2 showing improvement,and 1 showing no change. Among the 4 patients with chronic myelomonocytic leukemia(CMML), 2 patients achieved CR, and the other 2 patients achieved PR. One patient with multiple myeloma(MM) achieved PR, and the other one showed improvement. The treatment was discontinued in 2 patients because of the development of severe hepatic injury and bone marrow depression. No arsenic trioxide-related death was present. Conclusions For elderly patients with relapsed or refractory hematology malignancy who are unable to tolerate intensive chemotherapy,arsenic trioxide may be a practical alternative in spite of its toxic side effects which usually are manageable.