小剂量亚砷酸治疗复发性早幼粒细胞性白血病临床研究

SMALL DOSE ARSENOUS ACID IN TREATING RECURRENT PROMYELOCYTIC LEUKEMIA

目的 研究小剂量的亚砷酸治疗复发性早幼粒细胞性白血病 (APL)的临床疗效及毒副作用 ,初步探讨小剂量亚砷酸的作用机制。方法 对 1997～ 2 0 0 1年收治的复发APL患者进行回顾性分析 ,治疗组 :患者 2 0例 ,其中 18例为成年患者 ,治疗方法为亚砷酸 5mg d(0 .0 8mg kg)静脉滴注 ,连续 2 8d为 1疗程 ,2例患儿根据各自的体重相应接受 2mg d、3mg d亚砷酸治疗 ;对照组 :患者 2 1例 ,亚砷酸 10mg d(0 .16mg kg)静滴治疗。结果 治疗组 :16例获得缓解 (CR) ,占 80 % (16 / 2 0 ) ;2例未获缓解 ;2例治疗早期死亡。对照组 :17例患者获CR ,占 81.9% (17 2 1) ;4例在治疗早期死亡。 2组比较无显著性差异 (χ2 =0 .0 2 1,P =0 .886 )。小剂量亚砷酸的毒副作用较传统剂量组有明显的减轻。外周血和骨髓细胞形态学研究显示小剂量的亚砷酸在体内的作用机制 ,主要是诱导分化。结论 小剂量亚砷酸治疗复发性APL安全。

Objective To explore the curative effects of small dose arsenous acid in treating recurrent acute promyelocytic leukemia(APL) and its functional mechanism.Methods Retrospective analyses were made in the cases of recurrent APL from 1997 to 2001. In the treatment group, 18 adult cases received intravenous injection of 5mg/d arsenous acid with 28 days as a course of treatment and the other 2 cases received 2～3mg/d.In the contrast group, 21 cases received intravenous injection of 10mg/d arsenous acid.Results In the treatment group, 16 cases got remission,2cases got curative effects and 2 cases died early. In the contrast group, 17 cases got remission and 4 cases died early.The existed no significant difference between the two groups(χ 2=0.021,P= 0.886 ). Lower dose arsenous acid resulted in less toxic and side effects.Peripheral and marrow cell morphological studies showed that the main functions of low dose arsenous acid were induction and differentiation.Conclusion Low dose arsenous acid can be safely and effectively used to treat recurrent APL and its main mechanisms are induction and differentiation.