不同方案治疗老年高危急性早幼粒细胞白血病的临床疗效比较

Clinical efficacy and prognosis of different treatment regimens in elderly patients with high-risk acute promyelocytic leukemia

目的探讨不同治疗方案在老年高危急性早幼粒细胞白血病(APL)中的临床疗效。方法回顾性分析2009年1月~2020年10月南充市中心医院及川北医学院附属医院血液内科收治的64例老年高危APL患者为研究对象,根据不同治疗方案分为全反式维甲酸(ATRA)+化疗组(A组,n=20)、ATRA+三氧化二砷(ATO)(静脉)组(B组,n=22)、ATO+复方黄黛片(口服)组(C组,n=22),比较3组不同化疗方案对患者的疗效及生存影响。结果A组与B组、C组在早期死亡率、完全缓解率方面比较差异无统计学意义(P>0.05),在复发率方面比较A组显著高于B、C组(P<0.05);在心脏毒性及肝功能损伤率比较A组显著高于B、C组(P<0.05),在维甲酸综合征发生率比较差异无统计学意义(P>0.05);64例患者中位随访35.7个月,A组与B、C组之间生存期比较,A组低于B、C组(P<0.05)。B、C组之间生存期比较差异无统计学意义(P>0.05)。结论全反式维甲酸联合砷剂的治疗模式是老年高危APL患者较好选择,而中药复方砷剂因化疗毒副反应更轻为更佳选择。对老年高危APL患者的治疗选择具有临床指导性意义。

Objective To study the clinical efficacy and prognosis of three different treatment regimens in elderly patients with high-risk acute promyelocytic leukemia.Methods 64 elderly patients with high-risk APL treated in Department of Hematology of Nanchong Central Hospital and The Affiliated Hospital of North Sichuan Medical College from January 2009 to October 2020 were retrospectively analyzed.According to different treatment schemes,they were divided into all trans retinoic acid(ATRA)+chemotherapy group(group A,n=20),ATRA+arsenic trioxide(ATO)(intravenous)group(group B,n=22)ATO+compound Huangdai tablet(oral)group(Group C,n=22).The effects of different chemotherapy regimens on the efficacy and survival of the three groups were compared.Results There was no significant difference in early mortality and complete remission rate between group A,group B and group C(P>0.05).The recurrence rate of group A was significantly higher than that of group B and group C(P<0.05).The rates of cardiac toxicity and liver function injury in group A were significantly higher than those in group B and group C(P<0.05),and there was no significant difference in the incidence of retinoic acid syndrome(P>0.05).The median follow-up of 64 patients was 35.7 months.The survival time of group A was compared with that of group B and group C,Group A was lower than group B and group C(P<0.05).There was no significant difference in survival time between group B and group C(P>0.05).Conclusion The treatment mode of all trans retinoic acid combined with arsenic is a better choice for elderly patients with high-risk APL,while traditional Chinese medicine compound arsenic is a better choice because of less toxic and side effects of chemotherapy.It has clinical guiding significance for the treatment choice of elderly high-risk APL patients.