三氧化二砷联合全反式维甲酸治疗初发急性早幼粒细胞白血病临床分析

目的三氧化二砷联合全反式维甲酸治疗初发急性早幼粒细胞白血病的临床疗效(即完全缓解率和融合基因PML-RARα转阴情况)及不良反应。方法 46例初发APL患者随机分成研究组予As2O3联合ATRA治疗24例,对照组仅予ATRA治疗22例,均治疗直至CR。根据外周血白细胞计数、维甲酸综合征以及肝功能变化调整两药物的剂量。观察CR率、获得CR和不良反应。结果 46例初发APL患者,ATRA联合As2O3组24例患者中,CR23例,1例未缓解,缓解率95.8%,ATRA单药组22例患者中,CR17例,5例未缓解,缓解率77.3%。两组间CR率差异有统计学意义。65.0%患者在治疗开始后出现白细胞升高,63.8%出现肝功能异常,多在减量或停用后1周内恢复。所有患者融合基因PML-RARα初发时均为阳性,CR时9.8%转阴。结论 As2O3联合ATRA治疗初发APL疗效好,不良反应少。长期完全缓解时间需要进一步观察。

Clinical analysis of the treatment with combination of all-trans retinoic acid and arsenic trioxide in newly diagnosed acute promyelocytic leukemia

Objective To study whether all-trans retinoic acid with arsenic trioxide in acute promyelocytic leukemia treatment could further improve the clinical and molecular remission rate.Methods 46 cases of firty newly-diagnosed APL patients entered into the study.They were divided into observing group and control group.24 cases of patients were treated with ATRA combined with As2O3 until complete remission,the doses were adjusted according to white blood cell counts,occurrence of RA syndrome and 22 cases of patients were treated with ATRA until CR,the status of liver function.CR rate,time of reaching clinical and side effects were observed.Result Firty six newly-diagnosed APL patients,The observing group CR rate wsa 95.8%,the control group CR rate was 77.3%.Hyperleukocytosis emerged in 65.0% and hepatic damages in 63.8% of the patients,they were ameliorated within one week after reduction of the As2O3 dose or its suspension.The PMLRARαfusion gene that was positive in all 29 patients before treatment turned negative only in 3 cases(9.8%)after obtaining CR(CR1).Conclusion ATRA combined with As2O3 in de novo APL treatment can yield a high CR rate without intolerable side effects.Long term effect needs further observation.