全反式维甲酸联合三氧化二砷治疗初发急性早幼粒白血病的初步疗效观察

Observation of the Preliminary Clinical Efficacy by Combination All-Transretinoicacid with Arsenictrioxide for the Treatment of Newly Diagnosed Acute Promyelocytic Leukemia

目的观察全反式维甲酸(ATRA)联合三氧化二砷(As2O3)治疗急性早幼粒白血病(APL)的疗效和不良反应.方法ATRA 20～40mg/d,分2～3次服用;As2O3(0.1%溶液)10 mL加入5%葡萄糖溶液500mL中静脉点滴,持续4～6 h,1次/天,联合治疗初发APL.根据外周血白细胞计数、肝功能变化适当调整ATRA和As2O3的剂量.观察CR率、获得CR所需的时间、不良反应及近期缓解时间.结果16例初发APL患者早期死亡1例,15例获CR,CR率93.7%,获得CR的平均时间为(25.7±5.2)天.62.5%患者在治疗开始后出现白细胞升高,调整ATRA后均恢复.50%患者出现肝功能异常,经调整剂量及应用保肝药后均坚持应用As2O3至疗程结束.至今15例获CR的患者仍处于CR状态(2～26个月).结论ATRA联合As2O3治疗初发APL疗效好,不良反应少,而且能缩短达CR的时间.

Objective To observe the clinical efficiency of the combination with all-transretinoicacid(ATRA) and arsenictrioxide(As_2O_) in newly diagnosed acute promyelocytic leukemia(APL).Methods Sixteen newly diagnosed APL were treated with 20-40mg/d ATRA combined with 10 mg As_2O_ until complete remission (CR). The doses of ATRA were adjusted mainly according to white blood cell (WBC) counts, and the doses of As_2O_ were adjusted mainly according to the status of liver function. CR rate, time of reaching CR, short period efficiency and side effects were observed.Results One patient died 2 days after the treatment due to intracranialhemorrhage. Fifteen patients achieved CR, and the CR rate was 9.7%. The average time of getting CR was (25.7±5.2) days. Hyperleukocytosis emerged in 50% and hepatic damages in 4.8% of the patents, all of them were ameliorated after adjusting the dose of ATRA or As_2O_. Up to date (2 - 26 months fellow up), all 15 patients remained in CR. Conclusion Combination ATRA with As_2O_ in the treatment of APL can get a higher CR rate and a shorter duration for achieving CR.