CAJ | 학술논문

目的探索急性早幼粒细胞白血病(APL)经全反式维甲酸(ATRA)治疗达完全缓解(CR)后更佳的治疗方案.方法选择2000年1月至2007年10月新疆医科大学第一附属医院经ATRA诱导分化达CR的32例初治APL患者,巩固治疗选择标准的化疗方案,并根据患者年龄＜50岁使用中剂量阿糖胞苷(IDAra-C)而≥50岁不使用IDAra-C进行分层治疗.维持治疗则所有患者均采用ATRA、三氧化二砷(As2O3)及6-巯基嘌呤(6-MP)+甲氨蝶呤(MTX)3方案序贯交替治疗,并逐渐延长3方案之间的间歇期,持续3年结束治疗.观察患者治疗的效果.结果中位随访72(40～124)个月,巩固方案采用分层治疗后＜50岁患者及≥50岁患者预期5年无病生存率分别为94.7%、92.3%,两者差异无统计学意义(P＞0.05).32例患者中1例在巩固治疗中复发,1例在维持治疗中复发,其余患者仍持续缓解,其中16例已停止治疗且无病生存5年以上.32例患者经治疗后总的预期5年无病生存率为93.8%.结论 APL患者经ATRA诱导达CR后,经年龄分层进行治疗后长期生存率较高,不良反应轻微,表明此分层治疗方法是可行的.
목적 탐색급성조유립세포백혈병(APL)경전반식유갑산(ATRA)치료체완전완해(CR)후경가적치료방안.방법 선택2000년1월지2007년10월신강의과대학제일부속의원경ATRA유도분화체CR적32례초치APL환자,공고치료선택표준적화료방안,병근거환자년령＜50세사용중제량아당포감(IDAra-C)이≥50세불사용IDAra-C진행분층치료.유지치료칙소유환자균채용ATRA、삼양화이신(As2O3)급6-구기표령(6-MP)+갑안접령(MTX)3방안서관교체치료,병축점연장3방안지간적간헐기,지속3년결속치료.관찰환자치료적효과.결과 중위수방72(40～124)개월,공고방안채용분층치료후＜50세환자급≥50세환자예기5년무병생존솔분별위94.7%、92.3%,량자차이무통계학의의(P＞0.05).32례환자중1례재공고치료중복발,1례재유지치료중복발,기여환자잉지속완해,기중16례이정지치료차무병생존5년이상.32례환자경치료후총적예기5년무병생존솔위93.8%.결론 APL환자경ATRA유도체CR후,경년령분층진행치료후장기생존솔교고,불량반응경미,표명차분층치료방법시가행적.
Objective To explore an efficacious protocol for the patients with acute promyelocytic leukemia (APL) after a complete remission (CR) by all-trans retinoic acid (ATRA).Methods A total of 32 APL patients with an induction of CR by ATRA at our hospital from January 2000 to October 2007 received conventional standard chemotherapy as a consolidation regimen.Stratified according to age, those under 50 years old received an intermediate dose of cytarabine(IDAra-C) and over 50 years old non-IDAra-C regimen.Maintenance regimen:all patients received ATRA, arsenic trioxide (As2O3) and 6-mercaptopurine (6-MP) + methotrexate (MTX) alternately and sequentially for 3 years.The efficacy and side effects of these chemotherapies were observed.Results The median follow-up was 72 (40 - 124 )months.The 5-year disease-free survival (DFS) rates of under 50 years old and over 50 years old were 94.7% and 92.3% respectively.The difference was statistically insignificant ( P ＞ 0.05 ).One patient relapsed after a consolidation therapy and so did another on a maintenance regimen.Thirty patients achieved a constant CR.And 16 of 30 patients completed chemotherapy beyond 5 years and survived disease-free.The 5-year DFS rate of 32 patients was 93.8 %.Conclusion After the achievement of CR with ATRA, all APL patients have a higher rate of DFS after stratification.The side effects are generally mild.Thus a stratification therapy is both feasible and efficacious.