全反式维甲酸联合高三尖杉酯碱加阿糖胞苷诱导治疗高危急性早幼粒细胞白血病的临床疗效

目的:探讨维甲酸联合高三尖杉酯碱加阿糖胞苷诱导治疗高危急性早幼粒细胞白血病（APL）的临床疗效与安全性。方法:回顾性分析了2006年9月至2013年7月收治的17例高危APL患者的临床资料；全反式维甲酸剂量、高三尖杉酯碱及阿糖胞苷的中位平均剂量分别为27.2（10~60）mg/d、1（0.2~3）mg/d及50（10~200）mg/d；支持治疗包括连续输注纤维蛋白原、新鲜冰冻血浆、冷沉淀和/或单采血小板悬液。观察凝血功能状态对细胞毒药物化疗效果的影响。结果:17例患者中14例（82.3%）达完全缓解，缓解中位时间30 d,2例（11.8%）患者因脑出血而早期死亡，1例（5.9%）患者在维甲酸诱导治疗4 d后自动出院。结论:个体化剂量与疗程的维甲酸联合高三尖杉酯碱加阿糖胞苷是治疗高危APL的有效措施；化疗时的凝血机制改善是高危APL诱导治疗成功与否关键因素。

Clinical efficiency of all-trans retinoic acid combined with homoharringtonine plus cytarabine for induction therapy of patients with high-risk acute promyeocytic leukemia

Objective:To explore the clinical efficiency and safety of induction therapy of patients with high-risk acute promyeocytic leukemia(APL) by means of all-trans retinoic acid combined with homoharringtonine plus cytarabine.Methods:The clinical data of 17 patients with high-risk APL from September 2006 to July 2013 were analyzed retrospectively.The median average dosages of all-trans retinoic acid，homoharringtonine and cytarabine were 27.2（10~60）mg/d，1（0.2~3）mg/d and 50（10~200）mg/d，respectively.General therapy included fibrinogen，fresh-frozen plasma，cryoprecipitate and platelet transfusion.Effects of coagulation function on outcome of chemotherapy were observed.Results:14/17（82.3%）patients with APL obtained complete remission after treatment for median time of thirty days.2/17（11.8%）died of early intracranial bleeding.1/17（5.9%）refused medication following treatment with all-trans retinoic acid for four days.Conclusion:Personized treatments with all-trans retinoic acid combined with homoharringtonine plus cytarabine is an effective strategy for patients with high-risk APL.Coagulation function at time of chemotherapy plays pivotal role for successful treatment of patients with high-risk APL.