化疗、全反式维甲酸联合砷剂序贯治疗成人急性早幼粒细胞白血病疗效分析

目的 探讨急性早幼粒细胞白血病(APL)不同诱导缓解方案的缓解率和缓解时间及不同治疗方案对预后和生存率的影响.方法 回顾性分析初治APL患者73例,按照不同的诱导缓解治疗方案分为单纯化疗组、单纯全反式维甲酸(ATRA)治疗组、ATRA联合化疗组和ATRA联合砷剂(As2O3)组,比较各组的完全缓解(CR)率和达到CR的时间.达到CR的病例,按照不同的缓解后治疗方案分为两组,即化疗→ATRA→As2O3序贯治疗组、化疗与ATRA交替治疗组,比较两组3年总生存(OS)率、复发率、无病生存(DFS)率.结合诱导缓解与维持巩固治疗方案,将病例重新分为两组:应用ATRA和As2O3联合诱导缓解并以化疗→ATRA→As2O3序贯维持治疗者为双药诱导、序贯维持组,其他为非双药诱导、序贯维持组.比较两组的CR率、OS率和DFS率.结果 ①在诱导缓解治疗阶段,ATRA联合As2O3组的诱导缓解率高达100%,单纯化疗组57.1%,ATRA或ATRA联合化疗组78.8%,三者比较差异有统计学意义(P=0.030).达到CR的中位时间以ATRA联合As2O3组最短,为26(13～40)d.②在维持巩固治疗阶段,诱导缓解后序贯治疗组和化疗与ATRA交替治疗的3年OS率分别为(95.7±4.3)%和(68.6±11.2)%,3年DFS率分别为(79.0±9.5)%和(32.9±15.5)%(P＜0.05).序贯治疗组的复发率为14.8%,明显低于化疗与ATRA交替治疗组(50.0%).③双药诱导、序贯维持组患者CR率、3年OS和DFS率均达到100%.非双药诱导、序贯维持组CR率为72.9%,3年OS率为(72.3±9.1)%,两组的差异具有统计学意义(P＜0.05).结论 ATRA联合As2O3的诱导缓解率高,达到诱导缓解时间短.化疗、ATRA、As2O3序贯进行诱导缓解后治疗的复发率低,生存和无病生存率高.将二者结合进行规范化治疗有助于进一步提高疗效、减少复发.

Efficacy analysis of sequential treatment with chemotherapy, ATRA and As(2)O(3) for acute promyelocytic leukemia

Objective To investigate the efficacy and treatment outcome of different induction regimens, and different post-remission therapies for adult acute promyelocytic leukemia (APL). Methods The outcome of 73 patients with newly diagnosed APL were retrospectively analyzed. According to the induction regimens, the patients were divided into three groups: chemotherapy-only ( 14 cases group Ⅰ ), all-trans retinoic acid (ATRA) or combined with chemotherapy (33 cases group Ⅱ ), and ATRA combined with arsenic trioxide (As2O3 ) (26 cases group Ⅲ ). The complete remission (CR) rate and the time to CR (TTC) were analyzed. After CR, the patients were divided into 2 groups for post-remission therapies: one with sequential treatment of chemotherapy/ATRA/As2O3 and the other with alternative treatment of chemotherapy/ATRA.The overall survival (OS), disease free survival (DFS) and relapse rate were compared between these two groups. Patients induced CR with both ATRA and As2O3, and then sequentially treated with chemotherapy/ATRA/As2O3 ( group A ), and those induced CR with ATRA or As2O3 alone and then with non-chemotherapy For induction treatment, the CR rate in ATRA and As2O3 combination group was 100% , in ATRA combined with chemotherapy group was 78.8%, and in chemotherapy-only group was 57.1% ( P =0. 030). The median TTC in ATRA with As2O3 combination group was 26( 13 -40)days being the shortest among the three and (68.6 ±11.2)% ( P ＜0.05), and 3-year DFS rates were (79.0 ±9.5)%, and (32.9 ±15.5)%, respectively (P＜0.01). The relapse rate was 14.8% in group Ⅰ , and 50.0% in group Ⅱ (P=0.011).duced group was 72.9%, and 3-year OS was (72.3 ± 9.1 ) % ( P ＜ 0. 05 ). Conclusions For adult APL induction with ATRA and As2O3 combination can obtain a higher CR rate, and shorter TTC. The post-remission treatment with sequential chemotherapy, ATRA and As2O3 results in a lower relapse rate, and significantly improves OS and DFS. The ATRA and As2O3 combination induction with the sequential post-remission therapy is the best strategy for APL treatment.