全反式维甲酸与砷剂联合化疗治疗初诊儿童急性早幼粒细胞白血病6例临床观察  

Therapeutic efficacy of chemotherapy with all-trians retinoic acid combined with arsenic trioxide for acute promylocytic leukemia

作　　者：文金全[1] 王旭青[1] 刘安生[1] 李丹[1] 王华[1] 庞菊萍[1] 

机构地区：[1]西安市儿童医院血液科,陕西西安710003

出　　处：《中国实用儿科杂志》2008年第2期112-114,I0001,共4页Chinese Journal of Practical Pediatrics

摘　　要：目的探讨全反式维甲酸（ATRA）与砷剂联合化疗对儿童初诊急性早幼粒细胞白血病（APL）的疗效和不良反应。方法1994年10月至2006年5月在西安市儿童医院共收治儿童APL6例,男2例,女4例。诱导缓解期：例1用ATRA联合化疗,例2用DAE[（D：柔红霉素（DNR）;A：阿糖胞苷（Ara-C）;E：足叶乙甙（Vp16）]方案无效,换用ATRA和三氧化二砷（As2O3）治疗。例3-6用ATRA、As2O3联合化疗。巩固治疗：例1用DA方案,例2用As2O3,例3-6用DAE方案。维持治疗：例1、2用青黄散、化疗、6-巯基嘌呤（6-MP）和甲氨蝶呤（MTX）各1个月交替用药。例3-6用大剂量阿糖胞苷（HD-Ara-C）4-6个疗程,其间间隙用DA、HA（H：高三尖杉酯碱）方案,共8-10个疗程以后,再交替用As2O3、6-MP＋MTX、ATRA各1个月,总疗程3年。结果例1诱导缓解期第45天获完全缓解（CR）,余5例均在第30天达CR,期间无严重出血及骨髓抑制,不良反应有恶心、腹痛、皮疹、心电图异常。随访11-152个月,均为持续完全缓解,例2-6获分子生物学缓解,3例分别停药116、16、14个月。血砷测定均未达到中毒浓度。结论砷剂联合ATRA、化疗适合初诊儿童APL的治疗,总体预后良好。Objective To investigate the therapeutic efficacy and the side-effects of chemotherapy with all-trians retinoic acid （ ATRA）, chemotherapy with arsenic trioxide and chemotherapy for children with original acute promylocytic leukemia （APL）. Methods In remission induction,case 1 was treated with ATRA chemotherapy, case 2 was treated with ATRA and As2 03, cases 3 - 6 were treated with combination of ATRA and As2 03 chemotherapy. In postremission therapy, case 1 was treated with DA,case 2 was treated with As2O3 ,and cases 3 - 6 were treated with DAE. In maintenance therapy, case 1 and 2 were treated with Qing Huang San,chemotherapy,6-MP and MTX monthly in turn. Cases 3 - 6 were treated for 4 - 6 periods with HD-Ara-c. In intermission of HD-Ara-c,the patients were treated for 8 - 10 periods with DA and HA,and then one month with As2O3 ,6-MP and MTX,ATRA respectively. All period of treatment was 3 years. Results Case 1 obtained complete remission at 45 days after remission therapy. Others obtained complete remission at 30 days. There were no severe bleeding and inhibition of bone marrow. Side-effects of treatment were nausea, bellyache, tetter and abnormal ECG. The patients remained in CR at 14 - 116 months. Chromosomal abnormalities returned to normal in case 2 - 6. Conclusion The combination of ATRA and arsenic trioxide chemotherapy is safe and effective in children with original APL.

关 键 词：维甲酸 三氧化二砷 儿童 白血病 早幼粒细胞 急性 

分 类 号：R72[医药卫生—儿科]