三氧化二砷联合全反式维甲酸治疗初发急性早幼粒细胞白血病的临床观察

目的 观察全反式维甲酸(ATRA)联合三氧化二砷(As2O3)治疗初诊急性早幼粒细胞白血病(APL)的疗效及不良反应.方法 对ATRA每天25mg/m2联合As2O310mg/d(联合组)治疗的35例APL患者达完全缓解(CR)时间、CR率、早期病死率及不良反应进行观察,并与单用As2O3 10 mg/d(单药组)治疗的33例进行比较.结果 联合组CR率为94.3%(33/35),与单药组90.9%(30/33)]比较差异无统计学意义(P>0.05);联合组获得CR时间为26.1 d,短于单药组的30.5 d,差异有统计学意义(P<0.05);联合组与单药组APL分化综合征及不良反应发生率、早期病死率比较,差异均无统计学意义(均P>0.05);高WBC组比中、低WBC组CR率低,死亡率高,差异均有统计学意义(均P<0.05),低WBC组与中WBC组差异无统计学意义(P>0.05).结论 As2O3联合ATRA较单用As2O3治疗初诊APL获得CR时间短,WBC>10×109/L为预后不良的因素,APL分化综合征应尽早发现,及时处理.

Clinical observation of arsenic trioxide with ATRA on newly-diagnosed patients of acute promyelocytic leukemia

Objective To investigate the therapeutic efficacy and side effects of arsenic trioxide (As2O3) with ATRA on newly-diagnosed patients with acute promyelocytic leukemia (APL). Methods 35 patients of newly-diagnosed APL received As2O3 with ATRA treatment. The therapeutic effects were compared with As2O3 treatment on 33 patients. The dose were adjusted according with As2O3 0.16 mg·kg-2·d-1 and ATRA 25 mg·m-2·d-1 until complete remission (CR). The CR rate, period to CR, the incidence of early death and side effects were observed in two groups. Results There was no significant difference in CR rate, in which 94.3 % for As2O3 with ATRA group and 90.9 % for As2O3 group (P >0.05). Significant difference was observed in the period to CR, in which the medium time to CR was 26.1 days for As2O3 with ATRA group and 30.5 days for As2O3 group (P <0.05). No significant differences was detected in APL associated syndrome, the occurrence of cytoxic responses and the incidence of early death. The death rate was higher in high WBC group than that in middle and low WBC group, with statistical difference (P <0.05), but there was no obvious difference between lower WBC and middle WBC group (P >0.05). Conclusion The treatment combined with As2O3 and ATRA could lessen the time of reaching CR. The WBC count > 10×l09/L was one of the main causes of therapy associated death and the APL differentiation syndrome should be detected and given attention immediately.