三氧化二砷联合小剂量MA方案治疗慢性粒细胞白血病的分析

Curative Effects Analysis of Treating CML by As_2O_3 and small dose of MA

目的:探讨三氧化二砷(As2O3)联合小剂量MA方案治疗慢性粒细胞白血病(CML)后的血液学、细胞遗传学缓解率及急变率的改变,从而为治疗慢性粒细胞白血病寻找的新的方法。方法:三氧化二砷联合小剂量MA方案:三氧化二砷10mg/d,d 1～28;小剂量的MA方案:米托蒽醌10mg/d;d 1～3;阿糖胞苷(Ara-c)50 mg/d,d 1～14;28d为1个疗程。3个疗程结束后统计血液学缓解率,每半年检查pH染色体,并且与单独使用羟基脲治疗CML对照比较。结果:三氧化二砷联合小剂量MA方案治疗25例,3个月后有21例获得血液学完全缓解,缓解率80.4%;羟基脲组25例,3个月后有13例获得血液学完全缓解,缓解率52%(P<0.05)。观察36个月,三氧化二砷联合小剂量MA方案治疗组中有11例获得遗传学完全或部分缓解,缓解率44%,仅1例发生急变,急变率为4%。羟基脲对照组36个月无1例出现细胞遗传学缓解,有7例出现加速或急变,急变率为28%。两者比较差异有统计学意义(P<0.05)。结论:三氧化二砷联合小剂量MA方案可显著提高CML患者血液学和细胞遗传学缓解率,减少pH染色体阳性细胞,降低急变率,从而延长CML患者的生存期。

Objective：To study the effects of the combination therapy of As203 and small dose of MA in the cure of CML by the change of hematologic remission ,cytogenetic response and the rate of acute change.Method：The combina- tion therapy of As203 and small dose of MA： As203 10mg/d,dl-28, mitoxantrone 10mg/d,dl-3, Ara-c50 mg/d, dl-14, 28d of a course of treatment .Analyse the rate of hematologic remission after three courses of treatment and check the ph chromosome every half year, and compare the group of combination therapy of As203 and small dose of MA with the group of theray of hydroxylurea.Result：Of the 25 cases of the combination therapy of As203 and small dose of MA, 21 achieve CHR after three monthes,and the rate of CHtl is 80.4%; Of the 25 cases of the hydroxylurea, 13 achieve CHR after three monthes,and the rate of CHR is 52% （P〈0.05）oAfter 36 mothes, 11 achieve completely or partially genetics alleviatation of combination therapy of As203 and small dose of MA group,and the rate of alleviatation is 44%, and only one ease of acute change ,and the rate is 4%.In the contract, After 36 mothes, none achieves cytogenetic alleviatation of the the hydroxylurea group,7 cases of acute change ,and the rate is 28% and There was significant difference be- tween the two groups （P〈0.05） Conclusion： The rate of hematologic and cytogenetic alleviation are greatly increased by the combination therapy of As203 and small dose of MA,and the cells of ph chromosome and the rate of acute change.decreasd,Therefore, the life soan of the oatient of CML orolonged.