吡柔比星巩固治疗急性早幼粒细胞白血病疗效研究

Effects of Pirarubicin in the Consolidation Chemotherapy of Acute Promyelocytic Leukemia

目的:探讨吡柔比星巩固治疗急性早幼粒细胞白血病(APL)疗效及不良反应方法:回顾性分析2006年1月至2011年8月北京大学深圳医院血液科收治的初治APL患者72例,完全缓解58例,分为TA组(吡柔比星+阿糖胞苷)26例和DA组(柔红霉素+阿糖胞苷)32例,比较两组疗效及不良反应。结果:58例患者中复发5例,其中TA组1例,DA组4例,虽然无统计学差异,但TA组比DA组2年复发率更低(5.0%vs.13.0%),3年无病生存率更高(93.3%vs.76.5%)。两组血液学毒性的发生率及严重程度相似。但心脏毒性方面,TA组仅9.2%(11例)出现轻微短暂心电图T波改变,无1例出现ST-T改变、心律失常或心肌酶升高。心脏不良事件发生率低于DA组。结论:TA与DA方案巩固治疗APL疗效相似,不良反应两组间无显著差异,吡柔比星心脏毒性更低。TA方案可作为急性早幼粒细胞白血病巩固治疗化疗方案之一。

Objective： To explore the effectiveness and side effects of pirarubicin in the consolidation chemotherapy of acute pro- myelocytic leukemia （ APL ）. Methods： We retrospectively studied 58 cases of newly diagnosed APL that achieved complete remission （ CR ）. The patients were divided into two groups, with 26 cases in the TA group （ pirarubicin ＋ cytarabin ）, and 32 cases in the DA group （ daunorubicin ＋ cytarabin ）. Results： Of the 58 patients, 5 relapsed： 1 case in the TA group and 4 cases in DA group. Although no significant difference was observed between the two groups, the 2-year cumulative incidence of relapse was lower in the TA group than the DA group （ 5.0 % vs. 13.0 % ）. The 3-year event free survival （ EFS ） was higher in the TA group （ 93.3 % vs. 76.5 % ）. The incidence and the degree of hematologic toxicity were similar. A mild transient T-wave abnormality was observed in 9.2% of the chemotherapy cycles in the TA group. The TA group had a lower incidence of cardiac toxicity than the DA group. Conclusion： The TA and DA regimens have similar effects on the consolidation chemotherapy of APL. The difference in side effects between the two groups was not significant. Pirarubicin has a lower incidence of cardiac toxicity. The TA regimen （ pirarubicin ＋ cytarabin ） may be an alternative to APL consolidation therapy.