复发性难治性急性早幼粒细胞白血病的治疗分析

Therapeutic analysis of relapsed and refractory acute promyelocyfic leukemia

本组采用MA/MAE或HAE方案治疗12例复发性难治性急性早幼粒细胞白血病患者,总CR率83%,复发组10例的CR率达90%。5例采用全反式维甲酸(ATRA)作再诱导治疗,其中3例CR,1例PR,1例无效。3例复发系耐药,7例复发因停药6～22个月(中数11个月)。至今CR_2持续期为1～18个月(中数为6个月)。MA(E)方案的主要毒副作用为骨髓抑制,一般均可耐受。9例复发获CR_2者迄今存活12～47个月(中数39个月),其中2例第三次复发,1例第二次复发,6例处于持续缓解中。停药过长、化疗不力、多次重复ATRA或应用同一方案作缓解后治疗,均系引起复发的重要因素。

In 12 patients of relapsed and refractory acute promyeloeytic leukemia(APL)treated with protocols of mitoxantrone plus cytarabine(Ara-C),with or without etoposide(MAE)or H (Harringtonine)AE,total complete remission(CR)rate was 83%.CR rate reached to 90% in 10 cases of relapsed group.5 patients were reindueed by all-trans retinoic acid(ATRA),among which 3 cases were CR,1 was partial remission(PR)and 1 case was unresponsed.3 relapsed cases were resistance,7 relapsed cases were due to discontinue drugs for 6～22 months(medium 11 months),up to date the CR_2 durations were 1～18 months(medium 6 months).The suppression of bone marrow was the major side effect.Duration of survival was 12～47 months(medium 39 months)so far in 9 cases achieved CR_2,2 cases among them were 3 relapse,1 case was secondary relapse,6 cases were in continued remission.Long duration of discontinUe drugs,or insufficient intensity of chemotherapy,duplicated use of ATRA and same protocol were major factors causing relapse.