中华血液学杂志
中華血液學雜誌
중화혈액학잡지
Chinese Journal of Hematology
2011年
11期
752-757
,共6页
袁烨%李巍%林冬%秘营昌%王迎%魏辉%刘兵城%周春林%刘凯奇%王津雨%魏述宁%宫本法%赵邢力%孙明媛%王建祥
袁燁%李巍%林鼕%祕營昌%王迎%魏輝%劉兵城%週春林%劉凱奇%王津雨%魏述寧%宮本法%趙邢力%孫明媛%王建祥
원엽%리외%림동%비영창%왕영%위휘%류병성%주춘림%류개기%왕진우%위술저%궁본법%조형력%손명원%왕건상
白血病,早幼粒细胞,急性%治疗结果%预后
白血病,早幼粒細胞,急性%治療結果%預後
백혈병,조유립세포,급성%치료결과%예후
Leukemia,promyelocytic,acute%Outcomes%Prognosis
目的 观察高三尖杉酯碱(HHT)联合全反式维甲酸(ATRA)治疗初诊急性早幼粒细胞白血病(APL)患者的疗效及诱导治疗期间的不良事件发生情况,并与柔红霉素(DNR)联合ATRA治疗方案进行对比分析.方法 对2004年10月至2010年10月收治的115例APL患者的资料进行总结分析,其中HHT组54例、DNR组61例,对比分析两组患者的完全缓解(CR)率、总生存(0S)及无事件生存(EFS)情况.结果 115例APL患者CR率100％,达CR的中位时间32(22～43)d,109例进入巩固治疗的患者PML-RARα融合基因全部转为阴性,中位生存期未达(0.23～77.34个月),中位EFS期未达(0.23 ～ 77.34个月).3年OS率93％,5年OS率93％；3年EFS率85％,5年EFS率75％.诱导治疗后HHT组和DNR组PML-RARα融合基因转阴率分别为31.3％和15.5％；巩固治疗1个疗程后两组PML-RARα融合基因转阴率分别为68.6％和77.6％；DNR组有4例患者在巩固治疗＞1个疗程后转为阴性,但两组分子生物学复发率差异无统计学意义(9.8％和8.6％,P＞0.05).生存分析显示:HHT组与DNR组的OS、EFS相似(P值分别为0.206、0.506).两组5年OS率分别为87％和98％；5年EFS率分别为80％和71％.HHT组与DNR组的低/中危患者、高危患者OS、EFS亦相似(P值均＞0.05).诱导治疗期间HHT组合并2级以上发热患者比例显著低于DNR组,而肝、肾、心功能损伤及血液学不良反应发生率两组相似.结论 HHT和DNR为基础的方案治疗初诊APL疗效相似,同时在诱导治疗期间两者的耐受性无明显差异.
目的 觀察高三尖杉酯堿(HHT)聯閤全反式維甲痠(ATRA)治療初診急性早幼粒細胞白血病(APL)患者的療效及誘導治療期間的不良事件髮生情況,併與柔紅黴素(DNR)聯閤ATRA治療方案進行對比分析.方法 對2004年10月至2010年10月收治的115例APL患者的資料進行總結分析,其中HHT組54例、DNR組61例,對比分析兩組患者的完全緩解(CR)率、總生存(0S)及無事件生存(EFS)情況.結果 115例APL患者CR率100％,達CR的中位時間32(22～43)d,109例進入鞏固治療的患者PML-RARα融閤基因全部轉為陰性,中位生存期未達(0.23～77.34箇月),中位EFS期未達(0.23 ～ 77.34箇月).3年OS率93％,5年OS率93％；3年EFS率85％,5年EFS率75％.誘導治療後HHT組和DNR組PML-RARα融閤基因轉陰率分彆為31.3％和15.5％；鞏固治療1箇療程後兩組PML-RARα融閤基因轉陰率分彆為68.6％和77.6％；DNR組有4例患者在鞏固治療＞1箇療程後轉為陰性,但兩組分子生物學複髮率差異無統計學意義(9.8％和8.6％,P＞0.05).生存分析顯示:HHT組與DNR組的OS、EFS相似(P值分彆為0.206、0.506).兩組5年OS率分彆為87％和98％；5年EFS率分彆為80％和71％.HHT組與DNR組的低/中危患者、高危患者OS、EFS亦相似(P值均＞0.05).誘導治療期間HHT組閤併2級以上髮熱患者比例顯著低于DNR組,而肝、腎、心功能損傷及血液學不良反應髮生率兩組相似.結論 HHT和DNR為基礎的方案治療初診APL療效相似,同時在誘導治療期間兩者的耐受性無明顯差異.
목적 관찰고삼첨삼지감(HHT)연합전반식유갑산(ATRA)치료초진급성조유립세포백혈병(APL)환자적료효급유도치료기간적불량사건발생정황,병여유홍매소(DNR)연합ATRA치료방안진행대비분석.방법 대2004년10월지2010년10월수치적115례APL환자적자료진행총결분석,기중HHT조54례、DNR조61례,대비분석량조환자적완전완해(CR)솔、총생존(0S)급무사건생존(EFS)정황.결과 115례APL환자CR솔100％,체CR적중위시간32(22～43)d,109례진입공고치료적환자PML-RARα융합기인전부전위음성,중위생존기미체(0.23～77.34개월),중위EFS기미체(0.23 ～ 77.34개월).3년OS솔93％,5년OS솔93％；3년EFS솔85％,5년EFS솔75％.유도치료후HHT조화DNR조PML-RARα융합기인전음솔분별위31.3％화15.5％；공고치료1개료정후량조PML-RARα융합기인전음솔분별위68.6％화77.6％；DNR조유4례환자재공고치료＞1개료정후전위음성,단량조분자생물학복발솔차이무통계학의의(9.8％화8.6％,P＞0.05).생존분석현시:HHT조여DNR조적OS、EFS상사(P치분별위0.206、0.506).량조5년OS솔분별위87％화98％；5년EFS솔분별위80％화71％.HHT조여DNR조적저/중위환자、고위환자OS、EFS역상사(P치균＞0.05).유도치료기간HHT조합병2급이상발열환자비례현저저우DNR조,이간、신、심공능손상급혈액학불량반응발생솔량조상사.결론 HHT화DNR위기출적방안치료초진APL료효상사,동시재유도치료기간량자적내수성무명현차이.
Objective To essess complete remssion( CR),the overall survival( OS),event-free survival(EFS) and adverse events of newly diagnosised acute promyelocytic leukemia (APL) with homoharringtonine(HHT) plus ATRA,to evaluate the therapeutic effect by comparing HHT plus ATRA with daunorubicin plus ATRA as induction regimen (HA with DA as post-remission regimen).Methods 115 APL patients (54 in HHT group,61 in DNR group) after long-term follow-up were enrolled in the analyses of clinical feature,chromosome karyotype,molecular biology,OS and EFS.Results The overall CR of 115 patients was 100％,the median interval to achieve hematological CR was 32 (22 -43 )days,the overall median OS was within 0.23 - 77.34 months,median EFS was within 0.23 - 77.34 months.3-year OS rate was 93％,5-year OS rate 93％,3-year EFS rate 85％ and 5-year RFS rate 75％ respectively.Converting to PML-RARα PCR-negative after the induction therapy in the HHT and DNR group was 31.3％ and 15.5％ respectively,at the end of 1 consolidation course was 68.6％ and 77.6％ respectively,while the remaining 4 patients tested PML-RARαPCR-negative at the end of 2 consolidation courses in the DNR group.While both groups obtained the identical molecular biology relapse rate (9.8％ and 8.6％,respectively).Survival analysis indicated that no significant difference was found on OS and EFS between the HHT group and the DNR group (P =0.206 and 0.506).5-year OS rate was 87％ for the HHT group while 98％ for the DNR group,5-years EFS rate was 80％ for the HHT group while 71％ for the DNR group.And the risk group was not the factor affecting OS and EFS( P =0.615 and 0.416 ).Grade 2 fever in the HHT group was less than in the DNR group during induction therapy.And no difference was found in terms of liver dysfunction,renal dysfunction,cardiac dysfunction,and hematologic toxicity between two groups.Conclusion Our study demonstrated comparable therapeutic effect of HHT or DNR on APL.HHT was also well tolerated and didn't cause serious adverse events.
