三氧化二砷治疗初治急性早幼粒细胞白血病疗效分析  

The responses of arsenic trioxide-based therapy in newly diagnosed acute promyelocytic leukemia

作　　者：徐岚[1] 陈芳源[1] 黄洪晖[1] 钟华[1] 钟璐[1] 沈莉菁[1] 朱坚轶[1] 韩洁英[1] 陈冰 

机构地区：[1]上海交通大学医学院附属仁济医院血液科,200001 [2]上海血液病研究所

出　　处：《白血病．淋巴瘤》2010年第11期651-654,共4页Journal of Leukemia & Lymphoma

摘　　要：目的 分析以三氧化二砷（ATO）为基硇的诱导和维持治疗方案治疗初发急性早幼粒细胞白血病（APL）的长期疗效.方法 回顾性分析62例初诊成年APL患者诱导缓解治疗和缓解后巩固维持治疗经过,并作5、7年随访分析.结果 诱导治疗阶段,ATO＋全反式维甲酸（ATRA）双药联合化疗组与ATRA联合化疗组完全缓解（CR）率差异无统计学意义,但前者达到CR时间明显缩短.诱导治疗后PML-RARα融合基因转阴率两组分别为86.2%、56.3%,差异有统计学意义（P＜0.05）.巩固维持治疗阶段,ATO序贯维持组和化疗序贯维持组5年总生存（OS）率分别为（94.4±5.4）%和（45.5±10.2）%,7年OS率分别为（52.5±23.7）%和（27.3±9.3）%;两组5年无病生存（DFS）率分别为（94.7±5.5）%和（41.3±10.1）%,7年DFS率分别为（52.6±23.7）%和（275±9.4）%,两组差异有统计学意义（P＜0.05）.并且,ATO序贯维持组复发率（14.7%）低于化疗序贯维持组（37.0%）,差异有统计学意义（P＜0.05）.结论 以ATO联合ATRA、化疗的诱导化疗方案可缩短诱导化疗时间,提高PML-RAR α融合基因转阴率,而且,包含ATO的序贯维持治疗明显改善APL患者的长期生存,减少复发,安全性高,患者耐受性好.Objective To analysis long-term effects and safety of arsenic trioxide （ATO）-based induction and maintenance therapy in newly diagnosed acute promyelocytic leukemia （APL）. Methods Retrospective analysis induction remission and post-remission treatment of 62 newly diagnosed APL patients was performed. These cases were followed up for 5 and 7 years. Results The complete remission （CR） rate was similar in ATO/all-trans retinoic acid （ATRA） induction group and ATRA/chemotherapy induction group.However, the former group has the shorter time to CR. The negative rate of PML-RARα fusion gene after induction without ATO was less than that of ATO group （86.2 % vs 56.3 %, P 〈0.05）. After CR, the 5-year overall survival （OS） between ATO-base rotation maintenance group and chemotherapy-base rotation maintenance group showed that the former was （94.4±5.4） %, the latter is （45.5±10.2） %; 7-year OS was （52.5±23.7） % and （27.3±9.3） %; 5-year disease free survivals （DFS） was （94.7±5,5） % and （41.3±10.1） %; 7-year DFS was （52.6±23.7） % and （27.5±9.4） %. There was significant different in 5-year or 7-year OS and DFS between two groups （P 〈0.05）. The relapse rates of the two groups in post-remission treatment were 14.7 % and 37.0 % （P 〈0.05）. Conclusion ATO combined ATRA induction therapy increased the negative rate of PML-RARα fusion gene. ATO-base rotation maintenance improved long-term outcome and decreased the rate of relapse. Furthermore, ATO appeared to be generally safe and well tolerated.

关 键 词：白血病 早幼粒细胞 急性 砷剂 治疗 

分 类 号：R733[医药卫生—肿瘤]