三氧化二砷联合全反式维甲酸治疗急性早幼粒细胞白血病的意义研究

作者	单位
陶思	华中科技大学医学院附属同济医院血液科
周琨	华中科技大学医学院附属同济医院血液科
汤多壮	华中科技大学医学院附属同济医院血液科
孙汉英	华中科技大学医学院附属同济医院血液科
刘文励	华中科技大学医学院附属同济医院血液科
徐慧珍	华中科技大学医学院附属同济医院血液科
张恒	华中科技大学医学院附属同济医院血液科

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中文摘要:

目的探讨三氧化二砷(As2O3)与全反式维甲酸(ATRA)联合治疗急性早幼粒细胞白血病(APL)的临床意义。方法对80例急性早幼粒细胞白血病患者进行回顾性分析,将患者分为ATRA组和ATRA联合As2O3(联合)组,观察比较两组完全缓解(CR)率、早期病死率、外周血血红蛋白及血小板恢复时间、不良反应发生率等。结果对初发患者,联合组与ATRA组CR率分别为91.7%和87.5%,差异无统计学意义(P>0.05);联合组达CR时间、血红蛋白及血小板恢复时间分别为(28.0±7.8)天、(22.36±8.72)天和(19.38±9.52)天,而ATRA组分别为(47.7±10.9)天、(28.40±8.95)天和(28.03±7.29)天,联合组较ATRA组明显缩短;联合组早期病死率为7.1%,较ATRA组的13.2%有降低趋势(P>0.05);两组不良反应发生率差异无统计学意义(P>0.05)。结论ATRA与As2O3联合使用治疗初发APL患者,较单用ATRA治疗有其优势,有望降低早期病死率,且联用不加重不良反应。

英文摘要:

Objective To explore the significance of combined therapy of arsenic trioxide(As2O3) and all-trans retinoic acid(ATRA) in acute promyelocytic leukemia(APL).MethodsRetrospective study of 80 APL patients was performed and the complete remission(CR),the recovery time of peripheral hemoglobin and platelet,the early mortality,and the adverse reaction rates were analyzed between the ATRA group and the ATRA combined As2O3 group(combined group).ResultsCR rate of the combined group and the ATRA group was 91.7% and 87.5% respectively,which showed no significant difference;time of reaching CR,hemoglobin recovery,and platelet recovery for the combined group were 28.0±7.8 days,22.36±8.72 days and 19.38±9.52 days respectively,while those were 47.7±10.9 days,28.40±8.95 days and 28.03±7.29 days for the ATRA group,which suggested a significantly shorter period of the combined group of achieving recovery.With 7.1% compared to 13.2%,the early mortality of the combined group seemed lower than that of the ATRA group but with no significance observed(P>0.05).The adverse reaction rates of the two groups also lacked any significant difference(P>0.05).ConclusionCompared with using ATRA alone,the combined therapy of AS2O3 and ATRA was dominant in achieving CR and recovery for APL.Besides,the combined therapy carries the promise of reducing the early mortality with no aggravation of the adverse reaction.

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