急性早幼粒细胞白血病的诱导缓解及缓解后的强烈化疗

INDUCTION REMISSION AND POST REMISSION INTENSIVE CHEMOTHERAPY OF ACUTE PROMYELOCYTIC LEUKEMIA

１９８９年２月至１９９４年１０月单用全反式维甲酸（ＡＴＲＡ）或用ＡＴＲＡ１５天后改用化疗诱导治疗急性早幼粒细胞白血病（ＡＰＬ）４１例。除早期（服用ＡＴＲＡ１０天之内）中枢神经系统出血死亡５例外，其余３６例中，３４（９４．４％）例获得完全缓解（ＣＲ），其中用ＡＴＲＡ１５天后改用化疗诱导的１３例中达ＣＲ１１例，该１３例患者在改用诱导化疗后均未加重出血，诱发ＤＩＣ。３４例缓解患者中有２６例接受了６～１２疗程的缓解后强烈化疗，不进行维持化疗。其３年和５年的无病生存率均为５８．８％±１３．３％。结果提示服用ＡＴＲＡ１５天再化疗诱导ＡＰＬ是安全的，不诱发ＤＩＣ；缓解后强烈化疗可提高无病生存率；

Forty one patients with acute promyelocytic leukemia (APL) got induction remission with all trans rctinoic acid (ATRA) alonc or ATRA followed by chemotherapy 15 days after administration of ATRA from February 1989 to October 1994. Early death occured on five cases within 10 days after receiving ATRA. As to the other 36 patients, 34(94.4%) achieved complete remission(CR),including 11 of 13 patients who received ATRA followed by chemotherapy for induction. During induction chemotherapy, no severe hemorrhage and DIC occured during induction chemotherapy in the 13 patients. 26 of 34 patients who had achieved CR received 6～12 cycles of intensive consolidation regimens without prolonged maintenance chemotherapy. Both the 3 year and 5 year disease free survival(DFS) rates were 55.8%. Our results suggested that ATRA followed by chemotherapy 15 days after administration of ATRA for APL induction may be safe from fatal hemorrhage, that post remission intensive chemotherapy may improve 5 year DFS, and that prevention and correction of hemorrhage during early days of ATRA treatment is necessary.