全反式维甲酸、三氧化二砷联合化疗治疗初治急性早幼粒细胞白血病的临床观察

目的观察以全反式维甲酸(ATRA)和三氧化二砷(ATO)双诱导,联合化疗治疗初治急性早幼粒细胞白血病(APL)的疗效。方法对初治APL患者35例以ATRA和ATO进行双诱导,联合DA(柔红霉素+阿糖胞苷)方案化疗,达完全缓解(CR)后,采用DA、MA(米托蒽醌+阿糖胞苷)、HA(高三尖杉酯碱+阿糖胞苷)、MDAra-c(中剂量阿糖胞苷)、ATO序贯治疗,于每疗程化疗结束后连服ATRA 15 d,总治疗时间3年。结果35例初治APL患者中,1例早期死亡,未纳入评价,其余34例中,33例(97.1%)获得CR,1例(2.9%)未缓解(死于重症肺部感染)。2例(5.9%)发生维甲酸综合征(RAS)。随访至2009年5月,复发2例。3年总生存率、无病生存率分别为94.12%、91.18%。结论双诱导联合化疗治疗初治APL疗效可靠,患者可耐受治疗。

The clinical observation of all-trans retinoic acid and arsenic trioxide combined with chemotherapy in the treatment of newly diagnosed acute promyelocytic leukemia

Objective To analyze the therapeutic effect of double-induction all-trans retinoic acid （ ATRA ） and arsenic trioxide （ATO） combined with chemotherapy for the newly diagnosed patients with acute promyelocytic leukemia （APL）. Methods Thirty five newly diagnosed APL patients were treated with ATRA and AT（） combining with daunorubicin and cytarabine （DA） regimen as induction therapy. The postremission therapy was sequential therapy consisting of DA, MA （ mitroxantrone and cytarabine）, HA （ harringtonine and cytarabine）, MDAra-c （ middle dose cytarabine） and ATO, ATRA was administered to the patients orally after each cycle of chemotherapy. The overall treatment course was 3 years. Results Except for 1 patient died of intracranial hemorrhage at the early time of induction, 33 of 34 cases （97. 1% ） achieved CR and 1 case （2.9%） died of severe pulmonary infection. 2 cases （5.9%） of 34 patients developed the retinoic acid syndrome during induction. Follow up at the time May, 2009, there were 2 cases recun＇ed. The 3-year overall survival rate and free survival rate were 94.12% and 91.18% respectively. Conclusion For newly diagnosed patients with APL, the double induction ATRA and ATO combined with chemotherapy was highly effective and well tolerated.