维甲酸、三氧化二砷与化学治疗联合治疗急性早幼粒细胞性白血病34例疗效观察

摘要

目的：观察维甲酸、三氧化二砷与化学治疗(化疗)联合治疗急性早幼粒细胞性白血病的疗效.方法：将68例初诊住院治疗的急性早幼粒细胞性白血病患者随机分为治疗组和对照组各34例.治疗组采用去甲氧柔红霉素+阿糖胞苷化疗加全反式维甲酸、三氧化二砷诱导治疗,即：采用诱导治疗方案,全反式维甲酸每日25mg/m2,分3次口服,连续给药4~6周；三氧化二砷10mg,静脉滴注,1次/日,连续治疗2~4周,至骨髓形态学完全缓解.待诱导分化开始3~5日后予去甲氧柔红霉素[商品名善维达,通用名盐酸伊达比星,用法：(8~12)mg/m2/天,化疗第1天,第3天,第5天+阿糖胞苷(75mg/m2,1次/12h)]方案化疗.对照组采用IA方案,即：去甲氧柔红霉素+阿糖胞苷,剂量用法同前.两组疗程为28日,疗程结束后进行血常规和骨髓象检测,如果未达到完全缓解(CR),则进行下一疗程继续用药直至完全缓解.结果：PR再次用药达到完全缓解所需时间比较,治疗组显著短于对照组(P<0.05)；血常规恢复时间比较,治疗组优于对照组(P<0.05).结论：维甲酸三氧化二砷与化疗联合治疗急性早幼粒细胞性白血病短期疗效显著,达到完全缓解的时间缩短,血小板计数恢复快.%Objective:To investigate the clinical effects of tretinoin,arsenic trioxide on curing acute promyelocytic leukemia. Methods:Divide 68 patients who got the disease of acute promyelocytic leukemia,and received the tentative diagnosis and treatment in the hospital,into the treatment group and control group equally and randomly.The patients in both groups take with the same IA chemotherapy schedule.The patients in the treatment group take the induction therapy,namely,(25~45)mg/m2 of all- trans tretinoin per day,oral administration for three times, dosed for 4 to 6 weeks in a row.10 mg of arsenic trioxide, one time a day of intravenous drip,treated continuously for 2 to 4 weeks until the bone marrow morphology is remitted completely.The standard IA chemotherapy schedule will not be taken until the induced differentiation has proceeded for 3 to five days.The control group takes the single-purpose IA chemotherapy schedule,and the usage and dosage are the same as treatment group.28 days is a course of treatment in both groups.Result:if the purpose of complete remission (CR) is not achieved, continue using the medicine until complete remission.Results:The comparison of time for complete remission on PR( Partial remission) after medicine once again, the time of treatment group is lower than it in control group significantly(P<0.05).The comparison of recovery time on blood routine,the treatment group is superior to the control group (P<0.05). Conclusion:The short- term effects on acute promyelocytic leukemia with tretinoin,arsenic trioxide and chemotherapy is significant, the target of time contraction for complete remission is reached,and the recovery rate of platelet count is fast.