三氧化二砷与化疗分别联合全反式维甲酸治疗急性早幼粒细胞白血病的临床疗效研究  

Clinical observation of arsenic trioxide plus all trans retinoic acid versus ATRA combined with chemotherapy treatment on acute promyelocytic leukemia

作　　者：万佳[1] 秦大兵[1] 陈洁平[1] 

机构地区：[1]第三军医大学西南医院血液病科,重庆400038

出　　处：《重庆医学》2014年第31期4185-4187,共3页Chongqing medicine

基　　金：国家自然科学基金资助项目(NSFC;81270605;30971066);重庆市自然科学基金重点项目(CSTC;2008BA5001);重庆市研究生教育教学改革研究项目(yjg123114);第三军医大学重大临床科研课题(2101XLC03);军队重点医学科研项目基金

摘　　要：目的观察三氧化二砷(ATO)联合全反式维甲酸(ATRA)与以阿糖胞苷(Ara-C)为主联合ATRA的化疗方案诱导缓解治疗急性早幼粒细胞白血病(APL)的疗效。方法将2002年1月至2008年8月该科收治65例初治APL患者分为治疗组和对照组,治疗组(ATRA联合ATO治疗,27例)和对照组[ATRA联合DA(柔红霉素+Ara-C)、HA(高三尖酯碱+Ara-C)、NA(米托蒽醌+Ara-C)等以Ara-C为主联合化疗组,38例]。观察两组患者在完全缓解率(CR)、到达完全缓解时间、总生存率(OS)、无事件发生率(EFS)、5年无病生存率(DFS)及不良反应的差异。结果治疗组CR为81.48%,获得完全缓解平均时间(28.50±3.97)d;对照组完全缓解为68.42%,获得完全缓解平均时间为(30.56±2.39)d,两组比较差异无统计学意义(P>0.05)。两组完全缓解患者继续序贯治疗5年OS分别为51.9%和50.0%,差异无统计学意义(P>0.05)。两组完全缓解患者的5年EFS分别为48.1%和39.5%,二者差异无统计学意义(P>0.05)。两组患者5年DFS分别是55.6%和67.6%,差异无统计学意义(P>0.05)。治疗组不良反应中骨髓抑制明显低于对照组(P<0.05)。结论 ATRA联合ATO治疗初治APL患者可以获得较高的完全缓解、OS、EFS及5年DFS,ATRA联合化疗方案与之疗效相似。但ATRA+ATO骨髓抑制较ATRA联合治疗低,可能降低早期死亡风险。Objective To observe the efficacy of arsenic trioxide（ATO） combined all trans retinoic acid （ATRA） versus cytara‐bine （Ara‐C） combined ATRA in the treatment of acute promyelocytic leukemia（APL） .Methods We enrolled 65 patients in our department during the period between January 2002 and August 2008 ,and they were randomly assigned to receive ATRA combined ATO （treatment group ,n= 27） or ATRA combined DA ,HA ,NA which were major of Ara‐C （control group ,n= 38） .Then observe the differences of between the two groups ,such as complete remission（CR） ,the time to complete remission ,overall survival（OS） ,e‐vent free survival（EFS） ,the 5 years disease free survival （DFS） and adverse reactions .Results The CR rate of treatment group （ATRA ＋ ATO） and control group （chemotherapy ＋ ATRA） was 81 .48% and 68 .42% ,respectively ,and the time to complete re‐mission was （28 .50 ± 3 .97）d and （30 .56 ± 2 .39）d ,respectively ,showed that there was no statistical difference between the two groups （ P 〉 0 .05 ） .The 5 years DFS of the CR patients in the two groups was 51 .9% （ATRA ＋ ATO ） and 50 .0%（Chemotherapy ＋ ATRA） ,respectively ,showed that there was no statistical difference between the two groups（P 〉 0 .05） .The 5 years EFS of the CR patients in the two groups was 48 .1% and 39 .5% ,respectively ,showed that there was no statistical difference between the two groups（P〉 0 .05） .The 5 years DFS of the patients in the two groups was 55 .6% and 67 .6% ,respectively ,showed that there was no statistical difference between the two groups（P 〉 0 .05） .Bone marrow suppression in the treatment group was significantly lower than in the control group（P〈 0 .05） .Conclusion ATRA ＋ ATO can prolong the CR rate ,OS ,EFS and 5 years EFS of newly diagnosed APL patients .ATRA combined with chemotherapy has similar efficacy ,ATRA ＋ ATO has lower bone marrow suppression than the ATRA combined with chemotherapy ,thus may reduce th

关 键 词：维甲酸 阿糖胞苷 白血病  早幼粒细胞  急性 三氧化二砷 

分 类 号：R733.7[医药卫生—肿瘤] R733.71[医药卫生—临床医学]