急性早幼粒细胞白血病经全反式维甲酸治疗达缓解后分层治疗的探讨

Stratification therapy in patients with acute promyelocytic leukemia after a complete remission by alltrans retinoic acid

目的探索急性早幼粒细胞白血病（APL）经全反式维甲酸（ATRA）治疗达完全缓解（CR）后更佳的治疗方案。方法选择2000年1月至2007年10月新疆医科大学第一附属医院经ATRA诱导分化达CR的32例初治APL患者，巩固治疗选择标准的化疗方案，并根据患者年龄〈50岁使用中剂量阿糖胞苷（IDAra—C）而350岁不使用IDAra-C进行分层治疗。维持治疗则所有患者均采用ATRA、三氧化二砷（As2O3）及6-巯基嘌呤（6-MP）＋甲氨蝶呤（MTX）3方案序贯交替治疗，并逐渐延长3方案之间的间歇期，持续3年结束治疗。观察患者治疗的效果。结果中位随访72（40～124）个月，巩固方案采用分层治疗后〈50岁患者及≥50岁患者预期5年无病生存率分别为94．7％、92．3％，两者差异无统计学意义（P〉0．05）。32例患者中1例在巩固治疗中复发，1例在维持治疗中复发，其余患者仍持续缓解，其中16例已停止治疗且无病生存5年以上。32例患者经治疗后总的预期5年无病生存率为93．8％。结论APL患者经ATRA诱导达CR后，经年龄分层进行治疗后长期生存率较高，不良反应轻微，表明此分层治疗方法是可行的。

Objective To explore an efficacious protocol for the patients with acute promyelocytic leukemia （APL） after a complete remission （CR） by all-trans retinoie acid （ATRA）. Methods A total of 32 APL patients with an induction of CR by ATRA at our hospital from January 2000 to October 2007 received conventional standard chemotherapy as a consolidation regimen. Stratified according to age, those under 50 years old received an intermediate dose of cytarabine（IDAra-C） and over 50 years old non-IDAra-C regimen. Maintenance regimen： all patients received ATRA, arsenic trioxide （As203 ） and 6- mercaptopurine （6-MP） ＋ methotrexate （MTX） alternately and sequentially for 3 years. The efficacy and side effects of these chemotherapies were observed. Results The median follow-up was 72 （ 40 - 124 ） months. The 5-year disease-free survival （ DFS ） rates of under 50 years old and over 50 years old were 94. 7% and 92. 3% respectively. The difference was statistically insignificant （ P 〉 0. 05 ）. One patient relapsed after a consolidation therapy and so did another on a maintenance regimen. Thirty patients achieved a constant CR. And 16 of 30 patients completed chemotherapy beyond 5 years and survived disease-free. The 5-year DFS rate of 32 patients was 93.8 %. Conclusion After the achievement of CR with ATRA, all APL patients have a higher rate of DFS after stratification. The side effects are generally mild. Thus a stratification therapy is both feasible and efficacious.