急性早幼粒细胞白血病缓解后治疗的生存比较

The effects of different post-remission treatment on long-term survival of acute promyelocytic leukemia

目的比较急性早幼粒细胞白血病(APL)缓解后采用不同治疗方案对长期生存的影响。方法回顾性采用缓解后不同治疗方案的111例 APL 患者的长期生存情况。第1组:全反式维甲酸(ATRA)、三氧化二砷(As_2O_3)、化疗序贯治疗组40例;第2组:ATRA、化疗交替治疗组30例;第3组:As_2O_3、化疗交替治疗组26例;第4组:单纯化疗组15例。随访中位时间32(6～185)个月。结果随访截止时,有85例患者无病生存,18例死亡,8例失访。4组存活分别为(36/40、23/30、21/26、5/15)例;死亡(3/40、5/30、5/26、5/15)例;4组存活≥3年者分别为(16/40、12/30、11/26、1/15)例。111例患者预计5年总体生存率(OS)为(78.3±4.9)%,5年无复发生存率(RFS)为(76.9±5.1)%。治疗中有21例复发。结论 APL 患者缓解后接受联合治疗比单纯化疗具有更好的 OS 和RFS。ATRA、As_2O_3、化疗的序贯治疗方案对长期生存最有利。

Objective To Summarize and compare the effects of the different post-remission treatment on long-term survival in acute promyelocytic leukemia （APL） patients. Methods The long-term survival and relapse of 111 APL patients with different post-remission treatment were retrospectively analyzed. The patients were divided into four groups. Group 1 ： All-trans-retinoic acid （ATRA） ＋ As2 O3 ＋ chemotherapy; Group 2 ： ATRA ＋ chemotherapy; Group 3 ： As2O3 ＋ chemotherapy ; Group 4 ： chemotherapy alone. The median follow-up time was 32（6-185） months. Results A total of 85 patients survived without diseases, 18 patients died and 8 patients dropped out. In the four groups, the patients survived without disease were （36/40,23/30,21/26,5/15）, respectively. The cases of patients survived over 3 years were （ 16/40, 12/30, 11/26, 1/15 ）, respectively. The patients died were （ 3/40, 5/30, 5/26, 5/15 ）, respectively. The estimated 5-year overall survival （OS）and relapse-free survival （RFS） were （78.3 ± 4. 9 ）%, （76. 9 ± 5.1 ）% , respectively. There were 21 patients relapsed. Conclusion The APL patients receiving combined post-remission therapy had better OS and RFS those receiving chemotherapy alone. Sequential therapy combining ATRA, As2O3 and chemotherapy is the best post-remission therapy for longterm survival of APL patients.