三氧化二砷治疗初诊急性早幼粒细胞白血病的效果

TREATMENT OF PATIENTS WITH ACUTE CLINICAL STUDY ON ARSENIC TRIOXIDE IN THE PROMYELOCYTIC LEUKEMIA

目的探讨三氧化二砷（As2O3）治疗初诊急性早幼粒细胞白血病（APL）的效果及其不良反应。方法应用As2O3治疗初诊APL病人69例,如外周血白细胞〉30×10^9/L,给予羟基脲。如白细胞〉50×10^9/L,除给予羟基脲外给予高三尖杉酯碱,同时将As2O3剂量减半使用。并发DIC者应用小剂量肝素或低分子肝素皮下注射。结果69例初诊APL病人6例（8.7%）死亡,余63例均获完全缓解（CR）,CR率91.3%。As2O3平均应用31.6 d（21～58 d）。As2O3治疗过程中出现肝功能异常55例（79.7%）,消化道症状32例（46.4%）,水肿28例（40.6%）,类维甲酸综合征13例（18.8%）,过敏反应5例（7.2%）,发热4例（5.8%）,Q-T间期延长3例（4.3%）。其中类维甲酸综合征死亡4例（30.8%）。类维甲酸综合征发生时与入院时外周血白细胞计数比较,差异有显著性（P〈0.01）。结论应用As2O3治疗初诊APL可获得较高的CR率。类维甲酸综合征是As2O3治疗过程中最严重的并发症,其发生与治疗后白细胞升高有关。

Objective To investigate the therapeutic effect of arsenic trioxide（As2O3） on patients with newly diagnosed acute promyelocytic leukemia（APL） and its adverse effects. Methods Patients with newly diagnosed APL（n=69） received administration of As2O3.If leukocyte in peripheral blood exceeded 30×10^9/L,hydroxyurea was given.If leukocyte in peripheral blood were above 50×10^9/L,homoharringtonine was given besides hydroxyurea.Meanwhile dosage of As2O3 should be reduced to half.Patients complicated with DIC received small dosage of heparin or low-molecular weight of heparin intracutaneously. Results In 69 patients with newly diagnosed APL,six cases（8.7%） died and the others received complete response（CR）.CR rate was 91.3%.The mean duration of As2O3 administration was 31.6 days（21-58 days）.During administration of As2O3,55 patients were suffering from liver dysfunction（79.7%）,32 digestive symptoms（46.4%）,28 edema（40.6%）,13 retinoic acid syndrome（RAS,18.8%）,five allergy（7.2%）,four fever with unkown reason（5.8%）,and three Q-T interval prolongation（4.3%）.Four patients died from RAS（30.8%）.Leukocyte counts after As2O3 therapy,especially after diagnosis of RAS,were significantly highter than those before therapy. Conclusion Administration of As2O3 for patients with newly diagnosed APL brings about a high complete response rate.RAS is the most serious complication of As2O3 therapy and is related to hyperleukocytosis after therapy.