全反式维甲酸与亚砷酸联合化疗对急性早幼粒细胞白血病高危患者的疗效

目的观察全反式维甲酸(ATRA)与亚砷酸(ATO)联合化疗对急性早幼粒细胞白血病(APL)患者的疗效。方法回顾性分析86例不同危险分级的初治APL患者的临床资料。根据治疗前白细胞和血小板数将APL患者分为低、中、高危三组。采用ATRA+ATO+蒽环类药诱导缓解,蒽环类药+阿糖胞苷巩固治疗,ATRA+ATO+甲氨蝶呤(MTX)部分加用6-巯基嘌呤(6-MP)]维持治疗。结果治疗后,完全缓解(CR)率高达95.3%(82/86)。中位随访37个月,高危组和中低危组无事件生存率及中枢神经系统累积复发率差异均无统计学意义(P>0.05)。维持治疗单用MTX者或MTX+6-MP者CR率均为100%。结论 APL患者尤其是高危患者可以从ATO+ATRA+化疗中受益;该方案作为初治APL的一线治疗方案优势明显。

Outcomes of treating high-risk acute promyelocytic leukemia with all-trans retinoic acid combined with arsenic trioxide

Objective To observe the efficacy of all-trans retinoic acid(ATRA) combined with arsenic trioxide(ATO) in treating newly diagnosed acute promyelocytic leukemia(APL).MethodsEighty-six APL patients with various prognostic risks were retrospectively analyzed,who were divided into three groups of low,medium and high-risk according to the white blood cell and platelet count before treatment.The therapeutic regime was ATRA+ATO+daunorubicin for remission induction,daunorubicin+cytarabine(Ara-c) for consolidation therapy,and ATRA+ATO+methotrexate(MTX)plus 6-mercaptopurine(6-MP) in some cases] for maintenance treatment.Results The treatment with the regime achieved a high complete-remission(CR) rate of 95.3%(82/86).The patients were followed-up for a median period of 37 months.No differences in event-free survival(EFS) and cumulative incidence of relapse(CIR) of central nervous system were observed between the high-risk group and intermediate-risk or low-risk group(P>0.05).The CR rate in the patients treated with MTX alone or MTX+6-MP for the maintenance was 100%.Conclusion APL patients,especially with high-risk,can benefit from the combined therapy of ATO+ATRA+chemotherapy,which as a first-line therapy has remarkable advantage in the treatment of newly diagnosed APL.