急性早幼粒细胞白血病缓解后治疗的生存比较

目的比较急性早幼粒细胞白血病(APL)缓解后采用不同治疗方案对长期生存的影响。方法回顾性采用缓解后不同治疗方案的111例 APL 患者的长期生存情况。第1组:全反式维甲酸(ATRA)、三氧化二砷(As_2O_3)、化疗序贯治疗组40例;第2组:ATRA、化疗交替治疗组30例;第3组:As_2O_3、化疗交替治疗组26例;第4组:单纯化疗组15例。随访中位时间32(6～185)个月。结果随访截止时,有85例患者无病生存,18例死亡,8例失访。4组存活分别为(36/40、23/30、21/26、5/15)例;死亡(3/40、5/30、5/26、5/15)例;4组存活≥3年者分别为(16/40、12/30、11/26、1/15)例。111例患者预计5年总体生存率(OS)为(78.3±4.9)%,5年无复发生存率(RFS)为(76.9±5.1)%。治疗中有21例复发。结论 APL 患者缓解后接受联合治疗比单纯化疗具有更好的 OS 和RFS。ATRA、As_2O_3、化疗的序贯治疗方案对长期生存最有利。

The effects of different post-remission treatment on long-term survival of acute promyelocytic leukemia

OBJECTIVE: To Summarize and compare the effects of the different post-remission treatment on long-term survival in acute promyelocytic leukemia (APL) patients. METHODS: The long-term survival and relapse of 111 APL patients with different post-remission treatment were retrospectively analyzed. The patients were divided into four groups. Group 1: All-trans-retinoic acid (ATRA) + As(2)O(3) + chemotherapy; Group 2: ATRA + chemotherapy; Group 3: As(2)O(3) + chemotherapy; Group 4: chemotherapy alone. The median follow-up time was 32 (6 - 185) months. RESULTS: A total of 85 patients survived without diseases, 18 patients died and 8 patients dropped out. In the four groups, the patients survived without disease were (36/40, 23/30, 21/26, 5/15), respectively. The cases of patients survived over 3 years were (16/40, 12/30, 11/26, 1/15), respectively. The patients died were (3/40, 5/30, 5/26, 5/15), respectively. The estimated 5-year overall survival (OS) and relapse-free survival (RFS) were (78.3 +/- 4.9)%, (76.9 +/- 5.1)%, respectively. There were 21 patients relapsed. CONCLUSION: The APL patients receiving combined post-remission therapy had better OS and RFS those receiving chemotherapy alone. Sequential therapy combining ATRA, As(2)O(3) and chemotherapy is the best post-remission therapy for long-term survival of APL patients.