双诱导联合蒽环类抗生素治疗初治急性早幼粒细胞白血病疗效观察

Therapeutic Outcome of Double-induction Combined with Anthracycline for Newly Diagnosed Patients with Acute Promyelocytic Leukemia

目的观察以全反式维甲酸(all-trans retinoic acid,ATRA)和亚砷酸(As2O3)双诱导,联合蒽环类抗生素(anthracycline,ATC)为主的治疗方案治疗急性早幼粒细胞白血病(APL)的疗效。方法对初治APL患者以ATRA和As2O3进行双诱导,联合DA方案化疗,达完全缓解(CR)后,以ATC为主的方案巩固化疗6疗程,以后以化疗、ATRA、As2O3交替序贯维持治疗,化疗方案中仍以ATC为主。总治疗时间3年。14例患者接受了PML/RARα融合基因监测。结果21例初治APL患者中,除2例早期死亡外,其余19例诱导治疗后均达CR,经巩固、维持治疗,此19例患者至今均为持续完全缓解(CCR)状态,其中CCR5年以上2例,3年以上6例。无患者出现严重或不可逆的毒副反应。接受PML/RARα融合基因检测的14例患者,初诊时均为阳性,巩固治疗结束时均转为阴性,在以后监测中无一例转阳。结论双诱导联合ATC治疗初治APL,疗效可靠,毒副反应小。

Objective To analyze the therapeutic effect of double-induction combined with anthracycline （ATC） for the newly diagnosed patients with acute promyelocytic leukemia （APL）. Methods Twenty one newly diagnosed APL patients were treated with all-trans retinoic acid （ATRA） and arsenic trioxide （As2O3） combining with DA regimen as induction therapy. After complete remission （CR）, they underwent 6 courses of ATC-based consolidation chemotherapy and 2 years of maintenance therapy with ATRA, As2O3 and combined chemotherapy mainly composed of ATC, alternatively. The overall treatment time was 3 years. 14 cases were regularly monitored for PML-RARa fusion gene at the end of consolidation and in the following 2 years. Results Of the 21 APL cases, 19 achieved CR, 2 died of intracranial hemor- rhage at the early time of induction. All the 19 cases who achieved CR after double-induction were in continuous complete remission （CCR） condition so far, and 2 of them were in CCR for more than 5 years, 6 for more than 3 years. No case had serious or irreversible side effects during treatments. All the 14 cases were proved PML-RARα fusion gene negative at the end of consolidation, and none of them got positive afterwards. Conclusion For newly diagnosed patients with APL, double-induction combined with ATC is a highly effective and safe regimen.