三氧化二砷辅助治疗难治或复发急髓白血病的疗效观察

目的:研究三氧化二砷（As2O3）联合小剂量高三尖杉酯碱（homoharringtonine，HHT）、阿糖胞苷（Ara-c）治疗难治或复发性急性髓细胞白血病（relapsed acute myeloid leukemia，RAML）的疗效及不良反应。方法:难治或复发性急性髓细胞白血病患者180例随机分成两组:研究组94例，方案:三氧化二砷10mg/日，d1-5、d8-12静脉滴注，高三尖杉酯碱1mg/日，d1-14静脉滴注，阿糖胞苷25mg,皮下注射2次/日，d1-14。对照组86例，给予标准剂量HA方案:用药剂量疗程同前，不加As2O3。 结果:研究组68例获得完全缓解（CR），CR率72.3％（68/94），13例获得部分缓解（PR），总有效率（ORR）86.2％（81/94）。对照组CR率54.7％（47/86），9例PR，总有效率65.1％。两组比较研究组完全缓解率、部分缓解率以及总有效率均优于对照组（P＜0.05），不良反应发生率研究组与对照组无显著差异（P＞0.05）。结论:小剂量阿糖胞苷方案治疗难治复发性AML的疗效比标准剂量HA方案疗效优越，化疗相关不良反应无显著差异。

Effect of refractory or relapsed acute myeloid leukemia treated by arsenic trioxide

Objective:To study the effect and adverse reaction of arsenic trioxide (As2O3) combined with small dose of homoharringtonine (HHT),cytarabine (Ara-c) in treatment of refractory and relapsed acute myeloid leukemia (RAML).Method:All 180 patients of refractory and relapsed acute myeloid leukemia patients were randomly divided into two groups:94 cases in study group,the scheme:arsenic trioxide 10mg/day in d1-5,d8-12 intravenous drip;Homoharringtonine 1mg/days,d1-14 intravenous drip,Ara 25mg,subcutaneous injection of 2/days,d1-14.86 cases in control group,treated with a standard dose HA regimen:As previous without As2O3.Results:In study group 68 patients got complete remission(CR),the CR rate was 72.3% (68/94),13 cases partial remission(PR),the total efficiency was 86.2%.CR in control group was 54.7% (47/86),9 cases were PR,the total efficiency was 65.1%.The rate of complete remission,partial remission rate and total effective rate in study group was better than the control group(P＜0.05),the incidence of adverse reactions in study group and the control group had no significant difference(P＞ 0.05).Conclusion:The curative effect of small dose cytarabine in treatment of refractory and relapsed AML is superior than the effect of a standard dose of HA scheme,there was no significant differences in adverse reaction of chemotherapy.