中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2010年
5期
328-332
,共5页
马向娟%任汉云%岑溪南%邱志祥%王文生%欧晋平%王颖%许蔚林%李渊%王茫桔%王莉红%董玉君%尹玥%梁赜隐
馬嚮娟%任漢雲%岑溪南%邱誌祥%王文生%歐晉平%王穎%許蔚林%李淵%王茫桔%王莉紅%董玉君%尹玥%樑賾隱
마향연%임한운%잠계남%구지상%왕문생%구진평%왕영%허위림%리연%왕망길%왕리홍%동옥군%윤모%량색은
白血病,早幼粒细胞,急性%诱导缓解后治疗%复发率%生存率
白血病,早幼粒細胞,急性%誘導緩解後治療%複髮率%生存率
백혈병,조유립세포,급성%유도완해후치료%복발솔%생존솔
Leukemia,promyelocytic,acute%Treatment,post-remission%Relapse rate%Survival
目的 探讨急性早幼粒细胞白血病(APL)不同诱导缓解方案的缓解率和缓解时间及不同治疗方案对预后和生存率的影响.方法 回顾性分析初治APL患者73例,按照不同的诱导缓解治疗方案分为单纯化疗组、单纯全反式维甲酸(ATRA)治疗组、ATRA联合化疗组和ATRA联合砷剂(As2O3)组,比较各组的完全缓解(CR)率和达到CR的时间.达到CR的病例,按照不同的缓解后治疗方案分为两组,即化疗→ATRA→As2O3序贯治疗组、化疗与ATRA交替治疗组,比较两组3年总生存(OS)率、复发率、无病生存(DFS)率.结合诱导缓解与维持巩固治疗方案,将病例重新分为两组:应用ATRA和As2O3联合诱导缓解并以化疗→ATRA→As2O3序贯维持治疗者为双药诱导、序贯维持组,其他为非双药诱导、序贯维持组.比较两组的CR率、OS率和DFS率.结果 ①在诱导缓解治疗阶段,ATRA联合As2O3组的诱导缓解率高达100%,单纯化疗组57.1%,ATRA或ATRA联合化疗组78.8%,三者比较差异有统计学意义(P=0.030).达到CR的中位时间以ATRA联合As2O3组最短,为26(13～40)d.②在维持巩固治疗阶段,诱导缓解后序贯治疗组和化疗与ATRA交替治疗的3年OS率分别为(95.7±4.3)%和(68.6±11.2)%,3年DFS率分别为(79.0±9.5)%和(32.9±15.5)%(P＜0.05).序贯治疗组的复发率为14.8%,明显低于化疗与ATRA交替治疗组(50.0%).③双药诱导、序贯维持组患者CR率、3年OS和DFS率均达到100%.非双药诱导、序贯维持组CR率为72.9%,3年OS率为(72.3±9.1)%,两组的差异具有统计学意义(P＜0.05).结论 ATRA联合As2O3的诱导缓解率高,达到诱导缓解时间短.化疗、ATRA、As2O3序贯进行诱导缓解后治疗的复发率低,生存和无病生存率高.将二者结合进行规范化治疗有助于进一步提高疗效、减少复发.
目的 探討急性早幼粒細胞白血病(APL)不同誘導緩解方案的緩解率和緩解時間及不同治療方案對預後和生存率的影響.方法 迴顧性分析初治APL患者73例,按照不同的誘導緩解治療方案分為單純化療組、單純全反式維甲痠(ATRA)治療組、ATRA聯閤化療組和ATRA聯閤砷劑(As2O3)組,比較各組的完全緩解(CR)率和達到CR的時間.達到CR的病例,按照不同的緩解後治療方案分為兩組,即化療→ATRA→As2O3序貫治療組、化療與ATRA交替治療組,比較兩組3年總生存(OS)率、複髮率、無病生存(DFS)率.結閤誘導緩解與維持鞏固治療方案,將病例重新分為兩組:應用ATRA和As2O3聯閤誘導緩解併以化療→ATRA→As2O3序貫維持治療者為雙藥誘導、序貫維持組,其他為非雙藥誘導、序貫維持組.比較兩組的CR率、OS率和DFS率.結果 ①在誘導緩解治療階段,ATRA聯閤As2O3組的誘導緩解率高達100%,單純化療組57.1%,ATRA或ATRA聯閤化療組78.8%,三者比較差異有統計學意義(P=0.030).達到CR的中位時間以ATRA聯閤As2O3組最短,為26(13～40)d.②在維持鞏固治療階段,誘導緩解後序貫治療組和化療與ATRA交替治療的3年OS率分彆為(95.7±4.3)%和(68.6±11.2)%,3年DFS率分彆為(79.0±9.5)%和(32.9±15.5)%(P＜0.05).序貫治療組的複髮率為14.8%,明顯低于化療與ATRA交替治療組(50.0%).③雙藥誘導、序貫維持組患者CR率、3年OS和DFS率均達到100%.非雙藥誘導、序貫維持組CR率為72.9%,3年OS率為(72.3±9.1)%,兩組的差異具有統計學意義(P＜0.05).結論 ATRA聯閤As2O3的誘導緩解率高,達到誘導緩解時間短.化療、ATRA、As2O3序貫進行誘導緩解後治療的複髮率低,生存和無病生存率高.將二者結閤進行規範化治療有助于進一步提高療效、減少複髮.
목적 탐토급성조유립세포백혈병(APL)불동유도완해방안적완해솔화완해시간급불동치료방안대예후화생존솔적영향.방법 회고성분석초치APL환자73례,안조불동적유도완해치료방안분위단순화료조、단순전반식유갑산(ATRA)치료조、ATRA연합화료조화ATRA연합신제(As2O3)조,비교각조적완전완해(CR)솔화체도CR적시간.체도CR적병례,안조불동적완해후치료방안분위량조,즉화료→ATRA→As2O3서관치료조、화료여ATRA교체치료조,비교량조3년총생존(OS)솔、복발솔、무병생존(DFS)솔.결합유도완해여유지공고치료방안,장병례중신분위량조:응용ATRA화As2O3연합유도완해병이화료→ATRA→As2O3서관유지치료자위쌍약유도、서관유지조,기타위비쌍약유도、서관유지조.비교량조적CR솔、OS솔화DFS솔.결과 ①재유도완해치료계단,ATRA연합As2O3조적유도완해솔고체100%,단순화료조57.1%,ATRA혹ATRA연합화료조78.8%,삼자비교차이유통계학의의(P=0.030).체도CR적중위시간이ATRA연합As2O3조최단,위26(13～40)d.②재유지공고치료계단,유도완해후서관치료조화화료여ATRA교체치료적3년OS솔분별위(95.7±4.3)%화(68.6±11.2)%,3년DFS솔분별위(79.0±9.5)%화(32.9±15.5)%(P＜0.05).서관치료조적복발솔위14.8%,명현저우화료여ATRA교체치료조(50.0%).③쌍약유도、서관유지조환자CR솔、3년OS화DFS솔균체도100%.비쌍약유도、서관유지조CR솔위72.9%,3년OS솔위(72.3±9.1)%,량조적차이구유통계학의의(P＜0.05).결론 ATRA연합As2O3적유도완해솔고,체도유도완해시간단.화료、ATRA、As2O3서관진행유도완해후치료적복발솔저,생존화무병생존솔고.장이자결합진행규범화치료유조우진일보제고료효、감소복발.
Objective To investigate the efficacy and treatment outcome of different induction regimens, and different post-remission therapies for adult acute promyelocytic leukemia (APL). Methods The outcome of 73 patients with newly diagnosed APL were retrospectively analyzed. According to the induction regimens, the patients were divided into three groups: chemotherapy-only ( 14 cases group Ⅰ ), all-trans retinoic acid (ATRA) or combined with chemotherapy (33 cases group Ⅱ ), and ATRA combined with arsenic trioxide (As2O3 ) (26 cases group Ⅲ ). The complete remission (CR) rate and the time to CR (TTC) were analyzed. After CR, the patients were divided into 2 groups for post-remission therapies: one with sequential treatment of chemotherapy/ATRA/As2O3 and the other with alternative treatment of chemotherapy/ATRA.The overall survival (OS), disease free survival (DFS) and relapse rate were compared between these two groups. Patients induced CR with both ATRA and As2O3, and then sequentially treated with chemotherapy/ATRA/As2O3 ( group A ), and those induced CR with ATRA or As2O3 alone and then with non-chemotherapy For induction treatment, the CR rate in ATRA and As2O3 combination group was 100% , in ATRA combined with chemotherapy group was 78.8%, and in chemotherapy-only group was 57.1% ( P =0. 030). The median TTC in ATRA with As2O3 combination group was 26( 13 -40)days being the shortest among the three and (68.6 ±11.2)% ( P ＜0.05), and 3-year DFS rates were (79.0 ±9.5)%, and (32.9 ±15.5)%, respectively (P＜0.01). The relapse rate was 14.8% in group Ⅰ , and 50.0% in group Ⅱ (P=0.011).duced group was 72.9%, and 3-year OS was (72.3 ± 9.1 ) % ( P ＜ 0. 05 ). Conclusions For adult APL induction with ATRA and As2O3 combination can obtain a higher CR rate, and shorter TTC. The post-remission treatment with sequential chemotherapy, ATRA and As2O3 results in a lower relapse rate, and significantly improves OS and DFS. The ATRA and As2O3 combination induction with the sequential post-remission therapy is the best strategy for APL treatment.
