维甲酸与三氧化二砷双诱导治疗急性早幼粒细胞白血病继发分化综合征的临床特征及其影响因素分析

Analysis on clinical characteristics and risk factors of differentiation syndrome in acute promyelocytic leukemia patients treated with retinoic acid and arsenic trioxide

目的:探讨全反式维甲酸(ATRA)联合三氧化二砷(AS2O3)双诱导治疗急性早幼粒细胞白血病(APL)继发分化综合征(DS)的临床特征及高危因素。方法:回顾性分析广东省东莞市人民医院收治的56例初诊为APL经ATRA联合AS2O3双诱导治疗患者的临床资料,其中继发DS 26例(DS组),未发生DS 30例(未发生DS组),对比分析继发DS患者的临床特征、预后情况及高危因素。结果:DS的总发生率为46.4%(26/56),发生时间为双诱导治疗后的2~25d(中位时间5d);DS组患者的临床特征以不同程度的周围性水肿及浆膜腔积液发生率最高,占84.6%(22/26),其中重症DS患者均出现周围性水肿,床边胸片均提示双肺渗出伴不同程度的胸膜腔积液;所有DS患者经及时加用化疗、激素等处理后,症状均得以控制,两组均获得完全缓解。两组患者初诊时危险度分层和治疗前PML/RAR亚型的构成比比较,差异有统计学意义(P<0.05);而年龄、性别、治疗前是否合并感染、是否存在弥散性血管内凝血(DIC)、是否继发真菌感染比较,差异均无统计学意义(均P>0.05)。多因素Logistic回归分析结果显示,初诊时危险度分层高危是DS发生的独立危险因素(P<0.05)。结论:ATRA联合AS2O3双诱导治疗APL继发DS的发生率相对较高,初诊时危险度分层高危是DS发生的独立危险因素;及时加用化疗、激素可有效控制DS症状,不影响其完全缓解率,亦未增加继发真菌感染的发生率。

Objective： To explore the risk factors and clinical characteristics ot differentlatlon syndrome （DS） in acuce promyelocytic leukemia （APL） patients treated with all trans retinoic acid （ATRA） and ar senie trioxide （AS2O3 ）. Methods： Clinical data from 56 newly diagnosed APL patients received ATAR plus AS2O3 induction therapy were retrospectively studied. According to whether DS occurred, these patients were divided into DS group （n=26） and non-NS group （n =30）. The clinical characteristics, prognosis of DS patients and risk factors for DS were analyzed. Results： The total incidence of DS was 46.4% （26/56）, at a median time of 5 days （range 3-28） after induction therapy. Some degree of peripheral edema and hy drops of serous cavity occurs in 84.6% of patients with DS. All severe DS patients exhibited peripheral edema and hydrops of serous cavity, and completely recovered after receiving chemotherapy. There were significant differences in the risk stratification of initial diagnosis and the PML/RARa subtype between the two groups （P〈0.05）. Multivariate logistic regression analysis revealed that the high risk stratification of initial diagnosis was an independent risk factor for DS （P〈0.05）. Conclusion： The incidence of DS in APL patients treated by ATRA and AS2 03 was relatively high. High risk stratification of initial diagnosis was an independent risk factor for DS. Timely taking chemotherapy and glucocorticoid therapy could effectively control DS symptoms without affecting the complete remission rate or increasing secondary fungal infection incidence.