急性早幼粒细胞白血病的治疗和预后分析

Long - term Survey and Prognostic Study inAcute Promyelocytic Leukemia

目的研究全反式维甲酸（ＡＴＲＡ）和三氧化二砷（ＡＳ２Ｏ３）治疗急性早幼粒细胞白血病（ＡＰＬ）的长期疗效和预后相关因素。方法回顾性总结７２例经ＡＴＲＡ诱导缓解的初治ＡＰＬ患者长期无复发生存和总生存情况，并采用单因素分析对预后因素进行研究。结果７２例患者的３年和５年无复发生存率（ＲＦＳ）和总生存率（ＯＳ）分别为：３２．５％、１８．４％和７３．８％、５８．５％。初发病例在诱导缓解和缓解后治疗中，联合应用ＡＴＲＡ和化疗以及发病时ＷＢＣ计数与预后相关。ＡＳ２Ｏ３治疗复发ＡＰＬ，完全缓解和生存均高于常规化疗十维甲酸组。结论ＡＴＲＡ可作为初发病例的标准诱导治疗；缓解后联合应用化疗和ＡＴＲＡ能延缓或降低复发；在复发病例中，Ａｓ2Ｏ３治疗是首选方案。

Objective We present the results of long - term follow up in 72 patients withacute promyelocytic leukemia (APL) treated by ATRA and As2O3 together with discussion onprognostic factors. Methods Seventy-two newly diagnosed patients with APL enteringCR with ATRA were consolidated with chemotherapy alone(31), ATRA+chemotherapy (30)and ATRA alone (11). For relapsed APL, patients were treated with ATRA andchemotherapy, As2O3 alone and As2O3 with chemotherapy respectively. Univariate analysiswas performed to identify the potential prognostic factors in both de novo and relapsedpatients. Results With a median follow- up of 45 months (5~75 months), the medianrelapse - free survival was 21 months and the median overall survival were not reached. Theestimated 3 - and 5 - year relapse - free survival (RFS) and over - all survival (OS) were32.5 %, 18.4% and 73.8%, 58.5 %. In de novo patients treated with combination of ATRA andchemotherapy in both induction and post - remission periods the initial peripheral leukocytecount was significantly related to survival. In relapsed patients, the treatment of AsZO3 withor without chemotherapy in consolidation after relapse remained statistically significant forCR as well as RFS and OS. Conclusion (1)ATRA is a very effective induction therapy andcan be considered as the first choice treatment for novo APL; (2)Addition of chemotherapy inboth induction and post - remission therapy can delay or decrease the possibility of relapsecompared to ATRA alone; (3) As2O3 is a very effective agent for relapsed APL and serves asan important prognostic factor for relapsed APL.