急性早幼粒细胞白血病治疗的远期疗效观察  

Long-term therapeutic outcome of patients with acute promyelocytic leukemia

作　　者：张莉 李睿 李大鹏 刘永泽 徐世才 郝玉书 肖志坚 

机构地区：[1]中国医学科学院、中国协和医科大学血液学研究所、血液病医院实验血液学国家重点实验室,天津300020

出　　处：《中华血液学杂志》2007年第1期15-18,共4页Chinese Journal of Hematology

基　　金：新世纪优秀人才支持计划资助项目

摘　　要：目的观察急性早幼粒细胞白血病（APL）治疗的远期疗效。方法对初诊APL患者用全反式维甲酸（ATRA）诱导缓解治疗，完全缓解（CR）后给予3～4个疗程巩固联合化疗，达分子生物学缓解后用ATRA和巯嘌呤（6-MP）＋甲氨蝶呤（MTX）交替维持治疗2年，在完成巩固治疗后及随后的4～5年用筑巢式RT—PCR检测PML—RARα融合基因定期监测微量残留病。结果共81例APL患者，75例（92．6％）达到CR，早期死亡（ED）率6．6％，ED患者确诊时外周血白细胞计数及早幼粒细胞比例明显高于CR者（P〈0．05）。65例（80．2％）患者接受了诱导缓解后巩固化疗，60例（92．3％）患者在3个疗程化疗后PML—RARα融合基因转阴，3例（4．6％）患者第4疗程结束后PML—RARα融合基因转阴。中位随访21．2（8．0～64．0）个月，血液学复发6例，复发率9．2％。Kaplan—Meier分析5年总生存（OS）率（86．6±4．6）％。65例接受了诱导缓解后巩固化疗的患者，5年无复发生存（RFS）率为82．7％。COX回归分析表明白细胞增高（〉10×10^9／L）为影响患者OS的惟一不利因素。结论经系统治疗80％以上的APL可望获得长期无复发生存。Objective To analyze the long-term therapeutic outcome of patients with acute promyeloeyrie leukemia（APL）. Methods Newly diagnosed APL patients were treated with ATRA as induction thera- py followed by 3 - 4 courses of combined consolidation chemotherapy and 2 year maintenance therapy with ATRA and 6-MP ＋ methrotrexate, alternatively. Patients were regularly monitored with nested RT-PCR for PML-RARα fusion transcript at the end of consolidation chemotherapy and in the following 4 to 5 years. Results A total of 81 patients with APL were entered the triM, 75 （92.6%） patients achieved CR . Early death（ED） rate was 6.6%. ED patients had significantly higher WBC count and higher percentage of peripheral promyeloeyte than those achieved CR. Of 65 patients received consolidation, 60 （ 92.3% ） were proved PML-RARet fusion gene negative at the end of the 3rd courses and 3（ 4.6% ） the end of the 4th courses of consolidation. The mean follow-up was 21.2 （ 8 - 64） months, 6 patients relapsed （ relapse rate 9.2% ）. The 5-year Kaplan-Meier estimates of overall survival （OS） rate was （ 86.6 ± 4.6 ） %. For 65 patients received consolidation therapy, the 5-year relapse-free survival （ RFS ） rate was 82.7%. COX-regression analyses showed only high WBC count（ 〉 10 × 10^9/L）had an adverse prognostic influence on OS. Conclusion More than 80% of APL patients treated with systemic therapy could experience long-term relapse-free survival.

关 键 词：白血病 早幼粒细胞 急性 治疗结果 

分 类 号：R686[医药卫生—骨科学]