维甲酸、砷剂及化疗3种方法治疗急性早幼粒细胞白血病疗效比较分析

A comparison analysis of therapeutic effects in treating acute promyelocytic leukemia with all-trans retinoic acid,arsenic trioxide and chemotherapy

目的总结和比较维甲酸、砷剂和化疗在急性早幼粒细胞白血病初治、复发和维持治疗的疗效和特点,并长期随访。方法收集APL病例,分为初治组、维持组和复发组。初治组再分为砷剂单用组、砷剂和维甲酸连续应用组、砷剂和维甲酸联合应用组;维持组再分为为规律使用砷剂组、偶尔使用砷剂组、化疗组;复发组再分为口服砷剂组、静脉砷剂组。临床观察,长期随访,采用SPSS系统软件分析所得数据。结果初治组中砷剂单用组缓解率89.6%,达缓解时间41d,砷剂和维甲酸连续应用组缓解率100%,达缓解时间39d,砷剂和维甲酸联合应用组缓解率100%,达缓解时间28d;维持组中长期生存率规律使用砷剂组、偶尔使用砷剂组和化疗组差异无显著性(P>0.05);复发组口服砷剂组缓解率75%、静脉砷剂组87.5%。结论APL初治诱导缓解治疗中联合应用优于单用或连续应用,正规维持治疗决定长期预后,高危病例应个体化治疗。

[Objective] To review our clinical experience and the usages of ATO and effectiveness in different APL patients.[Methods] Patients were divided into newly diagnosed,maintenance therapy and relapsed three group.Newly diagnosed group was redivided into three sub groups：ATO single group,ATO＋ATRA consecutive group and ATO＋ATRA concurrent group.Maintenance therapy group was redivided into ATO regular,ATO occasion and chemotherapy group.Relapsed group was redivided into oral and intravenous group.[Results] The complete remission（CR）was 89.6%in ATO single group,100%in ATO＋ATRA consecutive and 100% in ATO＋ATRA concurrent group,the mediam duration to CR was 41,39,28 days.Overall survival had no apparently difference among regular,occasion and chemotherapy group.In relapsed group,CR was 75% in oral and 87.5% in intravenous group.[Conclusion] It si a good method to treat newly diagnosed APL with ATO＋ATRA concurrently.Formal regular maintenance therapy depends on overall survival.High risk patients need individual therapy.