三氧化二砷治疗急性早幼粒细胞白血病疗效观察

The observation of the efficacy of the treatment with arsenic trioxide (As_2O_3) in acute promyelocytic leukemia (APL)

目的 :观察三氧化二砷 (As2 O3)治疗急性早幼粒细胞白血病的完全缓解率、高白细胞发生率、肝功损害及融合基因转阴率 ,并与维甲酸 (ATRA )的治疗情况进行比较。方法 :随机分为两组 ,As2 O3组 17例 ,ATRA组 2 1例 ,分别选用 0 .1% As2 O310 m L/ d,静脉滴注 ;ATRA2 5 mg· m- 2 · d- 1 ,分 3次服用。分别观察两组的完全缓解率 (CR)、不良反应以及融合基因转阴率。结果 :As2 O3组 15 / 17例 (88.2 % )获 CR,获得 CR时间为 (2 8.1± 4 .6 ) d;ATRA组 19/2 1例 (90 .4 % )获 CR,获得 CR时间为 (39.4± 8.6 ) d,两组之间 CR无明显差别 ,但 As2 O3组获得 CR时间明显缩短。高白细胞发生率 As2 O3组 10 / 15例 (6 6 .7% ) ,ATRA组 18/ 19例 (94 .7% ) ,P<0 .0 5。肝功能异常 ,As2 O3组 11/ 17例(6 4 .7% ) ,ATRA组 13/ 19例 (6 8.4 % ) ,P>0 .0 5。所有患者治疗前 PML- RARα融合基因阳性。 As2 O3组 CR时 ,2 /14例 (14 % )转阴 ,ATRA组 2 / 19例 (10 .5 % )转阴 ,P<0 .0 5。CR后 1a,As2 O3组 5 / 8例 (6 2 .5 % )转阴 ,ATRA组 4 /11例 (36 .3% )转阴 ,P<0 .0 5。As2 O3组 15例获 CR者 ,无 1例复发。ATRA组 19例获 CR者 ,4例 (2 1% )复发。结论 :与 ATRA相比 As2 O3获得 CR时间缩短 ,高白细胞发生率低 ,CR及

Objective:To study the efficacy of the treatment with arsenic trioxide (As 2O 3) in acute promyelocytic leukemia (APL) and compare with the efficacy of all-trans retinoic acid (ATRA).Methods:38 patients were divided into tow groups and treated with 0.1 % As 2O 3 10 mL/d,ATRA 25 mg·m -2·d -1,respectively.The complete remission (CR) rate,side effects such as hyperleukocytosis and hepatic damages and molecular remission were observed.Results:15/17 patients(88.2 %) treated with As 2O 3 achieved CR,the average time for achieving CR was (28.1±4.6)d;19/21 patients (90.4 %) treated with ATRA achieved CR,the average time for achieving CR was (39.4±8.6)d,P<0.05.Hyperleukocytosis emerged in 10/15(66.7 %) of the patients with As 2O 3 and in 18/19(94.7 %) with ATRA,P<0.05.Hepatic damages occurred in 11/17(64.7 %) of the patients with As 2O 3,and in 13/19(68.4 %) with ATRA,P>0.05.The PML-RAR α fusion gene were positive in all patients before treatment.The positive fusion gene turned negative in 2/14(14 %)patients with As 2O 3 and in 2/19(10.5 %)with ATRA after obtain CR,P<0.05.In 12 months after CR,gene turned negative in 5/8(62.5 %) with As 2O 3 and in 4/11(36.3 %)with ATRA,P<0.05.Up to now all 15 patients with As 2O 3 remain in CR,but 4(21 %)patients with ATRA had relapse.Conclusion:Compared with ATRA,As 2O 3 in APL treatment can shorten the time for achieving CR,decreased hyperleukocytosis occuring,increased the fusion gene turning negative and decreased the relapse of APL.