三氧化二砷治疗急性早幼粒细胞白血病七年总结——附242例分析  

Seven years’ summary report on the treatment of acute promyelocytic leukemia with arsenic trioxide——An analysis of 242 cases

作　　者：张鹏[1] 王树叶[1] 胡龙虎[1] 邱凤芹[1] 杨惠芬[1] 肖彧君[1] 李晓霞[1] 韩雪英[1] 周晋[1] 刘澎[1] 

机构地区：[1]哈尔滨医科大学第一临床医学院,150001

出　　处：《中华血液学杂志》2000年第2期67-70,共4页Chinese Journal of Hematology

摘　　要：目的　总结三氧化二砷 (As2 O3 )对急性早幼粒细胞白血病 (APL)的疗效和特点。方法　临床观察、随访 7年 ,用美国SAS系统软件分析所得数据 ,用原子吸收光谱法测定脑脊液及血砷含量。结果　 2 42例中初治组完全缓解 (CR)率 87.9% ,有效率 94.4% ,成人高于儿童。复发组 79例中 2 0例在用As2 O3 巩固治疗中复发 ,CR率 6 0 .0 % ,有效率 6 5 .0 % ;5 9例用其它药物巩固治疗中复发 ,CR率 6 9.5 % ,有效率 84.8%。难治组CR率 48.7% ,有效率 6 4.1%。初治组CR后 86例用As2 O3 巩固治疗 ,3年复发率 2 6 .7%。随访 136例 ,5年及 7年生存概率分别为 92 .0 %及 76 .7%。As2 O3 治疗相关不良反应轻。 412例中 6年内中枢神经系统白血病 (CNSL)发生 138例次 ,其中还表现有难治和髓外残留白血病以及髓外复发CNSL现象 ,预防性鞘内注射药物确能降低CNSL发生率。砷测定表明As2 O3 难以透过血脑屏障。结论　As2 O3 治疗APL的CR率、长期生存率高 ,复发率低 ,不良反应轻 ,与全反式维甲酸 (A TRA)和其它化疗药物无交叉耐药 ,其耐药发生率低 ,并可用于巩固治疗 ,As2 O3 是目前治疗APL较理想的药物。Objective To observe the effectiveness of arsenic trioxide(As 2O 3)in the treatment of acute promyelocytic leukemia(APL). Methods Data of clinical observation, seven year follow up survey were analysed with American SAS system software, concentration of arsenic in cerebrospinal fluid (CSF) was determined by atomic absorbing spectrum. Results The complete remission (CR) and effectiveness rates were 87.9% and 94.4% for the previously untreated group; 60.0% and 65.0% for the relapsed in As 2O 3 maintenance treatment group; 69.5% and 84.8% for the relapsed in other than As 2O 3 maintenance treament group; and 48.7% and 94.1% for the refractory group, respectively. In the perviously untreated group, the relapse rate at 3 years after CR was 26.7%. The probability of survival in 136 follow up survey patients was 92.0% and 76.7% at 5 years and 7 years, respectively. There were mild side effects. Central nervous system leukemia(CNSL) occured in 138 out of 412 cases in 6 years, including some refractory leukemia, extramedullary residual leukemia and extramedullary relapse. Prophylactic intrathecal injection could reduce the incidence rate of CNSL. Determination of arsenic concentration indicated that it was difficult for arsenic to penetrate the blood brain barrier . Conclusion The CR rate and long term survival are high and the relapse rate is low in APL patients treated with As 2O 3. There is no cross resistance between ATRA and As 2O 3 and other chemotherapeutic agents. As 2O 3 resistance occurs scarecely. It can also be used in maintenance treatment.

关 键 词：白血病 早幼粒细胞 急性 三氧化二砷 药物疗法 

分 类 号：R733.71[医药卫生—肿瘤]