急性早幼粒细胞白血病诱导治疗阶段不同辅助治疗方案的疗效比较

摘要

Objective To compare the clinical efficacy for acute promyelocytic leukemia( APL) between different adjuvant therapy used in the induction treatment. Methods The clinical data of 44 patients who newly diagnosed as APL were retrospectively analyzed. The patients were divided into high risk group ( n=15 ) and low/moderate risk group ( n=29 ) , and were given a fold induction therapy of all-trans retinoic acid(ATRA) and arsenic trioxide(ATO),then the two groups were divided into anthracyclines(daunorubicin) alone group and anthracyclines combined with cytosine arabinoside group(DA group) according to the adjuvant therapy used in the induction treatment. The rate of complete response(CR),early-stage mortality,PLT count and coagulation function recovery at the end of chemotherapy, and incidence of adverse reactions were observed in each group. Results No early-stage death occurred in the 44 patients with newly diagnosed APL. In the low/moderate risk group or high risk group,no statistically significant difference was observed between the anthracyclines alone group and the DA group in the CR rate,increment rate of peripheral blood PLT count,recovery rate of coagulation function,peak of WBC, incidence rate of differentiation syndrome, infection rate, rate of abnormal liver function, or deterioration rate of coagulation function (all P>0. 05),however,the time to CR in the anthracyclines alone group was significantly less than that in the DA group(P<0. 05). In the low/moderate group,and the rate of grade 3-4 bone marrow suppression in the anthracyclines alone group was lower than that in the DA group(P<0. 05). Conclusion On the basis of fold induction therapy of ATRA and ATO,the adjuvant therapy of anthracyclines alone can achieve better efficacy compared to the DA therapy,and it can reduce the rate of grade 3-4 bone marrow suppression in the low/moderate risk patients.%目的 比较急性早幼粒细胞白血病(APL)诱导治疗阶段不同辅助治疗方案的疗效.方法 回顾性分析44例APL初治患者的临床资料,将患者分为高危组15例及中低危组29例,均接受全反式维甲酸(ATRA)和三氧化二砷(ATO)双诱导治疗,再根据诱导治疗过程中采用的辅助治疗方案将每组分为单加蒽环类药物(柔红霉素)组和蒽环类药物与阿糖胞苷联用组(DA组).观察各组患者完全缓解(CR)率、早期死亡情况、化疗结束时PLT及凝血功能的好转情况以及诱导期间不良反应的发生情况.结果 44名初治APL患者均无早期死亡.低中危组和高危组中,单加蒽环类药物组与DA组的CR率、外周血PLT水平回升率、凝血功能好转率、WBC峰值、分化综合征发生率、感染率、肝功异常率以及凝血象恶化率,比较差异均无统计学意义(均P>0.05),但单加蒽环类药物组达CR所需时间明显短于DA组(P<0.05).低中危组中,单用蒽环类药物组3～4级骨髓抑制率低于DA组(P<0.05).结论 在ATRA和ATO双诱导治疗的基础上,单用蒽环类药物进行辅助治疗较DA方案可获得更好的疗效,且可以降低低中危患者的3～4级骨髓抑制率.