伊达比星为主的分层治疗方案对急性早幼粒细胞白血病的疗效分析  

Efficacy of Idarubicin-Based Stratified Therapy for Acute Promyelocytic Leukemia

作　　者：关伟[1] 李文君[1] 杨岚[1] 靖彧[1] 于力[1] 

机构地区：[1]解放军总医院血液科,北京100853

出　　处：《中国实验血液学杂志》2017年第2期353-357,共5页Journal of Experimental Hematology

摘　　要：目的:探讨全反式维甲酸(all-transretinoic acid,ATRA)联合亚砷酸(arsenious acid,ATO)双诱导治疗急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)的缓解率和伊达比星、全反式维甲酸、亚砷酸/复方黄黛片分层序贯巩固治疗的疗效。方法:收集2010年至2016年接受双诱导方案患者22例,分析双诱导的CR率、早期死亡率、并发症发生率和获得完全缓解的时间长短。完全缓解后低、中危患者接受1-2个疗程IDA单药化疗,ATRA和复方黄黛片/ATO交替治疗4个周期;高危患者接受IA化疗4疗程,ATRA和复方黄黛片/ATO交替治疗共4个周期。结果:双诱导完全缓解率100%,诱导治疗平均时间28.23±1.6 d,诱导期间50%发生感染,36.4%出现分化综合征,27.3%有不同部位出血。完全缓解后分层巩固治疗组5年总生存率100%,无复发生存95.4%;结论:APL患者接受ATRA和ATO双诱导治疗能够达到较高缓解率,诱导缓解时间短,并发症可控。采用IDA、ATRA和ATO分层序贯治疗作为缓解后巩固方案,能够降低复发率,延长患者的生存期,获得极高的治愈率。Objective： To investigate the remission rate of all-transretinoic acid （ATRA） combined with arsenics acid （ATO） on acute promyelocytic leukemia, and the efficacy and safety of sequential consolidation therapy with idarubicin, all-trans retinoic acid and arsenic trioxide/compound Huangdai tablet. Methods： Between January 2011 and January 2016 years 22 patients with newly diagnosed acute promyelocytic leukemia who received ATRA combined with ATO till complete remission in our hospital were retrospectively analyzed. Rates of CR, early mortality, complications and duration of induction were analyzed. The low/intermediate risk patients received 1 - 2 courses of idarubicin （IDA） single-agent chemotherapy, ATRA and compound Huangdai tablet/ATO alternative treatment of 4 cycles after complete remission ; the high-risk patients received idarubicin and cytarabine chemotherapy, ATRA and compound Huangdai tablet /ATO alternative treatment of a total of 4 cycles for double-induction group. Results： Double-induction achieved a 100% CR rates after 28.23 ±1.6 days induction. During induction, the infection rate was 50%, 36.4% of patients had differentiation syndrome and 27.3% suffered from bleeding in different locations. The 5-year overall survival was 100% and relapse-free survival was 95.4%. Conclusion： This protocol has a good antileukemic effect. The combination of ATRA and ATO achieves extremely high complete reminssion rate and reduces coagulopathy to cut down early mortality. Sequential therapy with IDA, ATRA, and ATO as a consolidation regimen results in satisfactory clinical outcomes with tolerable side effects.

关 键 词：急性早幼粒白血病 全反式维甲酸 亚砷酸 伊达比星 复方黄黛片 

分 类 号：R733.71[医药卫生—肿瘤]