三氧化二砷联合全反式维甲酸诱导治疗初治急性早幼粒细胞白血病患者疗效的影响因素分析

J4 ›› 2010, Vol. 36 ›› Issue (3): 558-562.

三氧化二砷联合全反式维甲酸诱导治疗初治急性早幼粒细胞白血病患者疗效的影响因素分析

杨倩倩, 崔久嵬, 李薇, 陈耐飞, 王冠军

吉林大学第一医院肿瘤中心,吉林长春 130021）

收稿日期:2009-09-23 出版日期:2010-05-28 发布日期:2010-05-28
通讯作者: 王冠军 E-mail:guanjunwang2006@163.com
作者简介:杨倩倩（1983-）,女|安徽省淮北市人|医师|医学硕士|主要从事急性白血病及淋巴瘤相关研究。
基金资助:
国家自然科学基金资助课题（30572138）

Analysis on influencing factors of |induction treatment of |arsenic trioxide in combination |with |all-trans retinoic acid in patients with newly diagnosed acute promyelocytic leukemia

YANG Qian-Qian, CUI Jiu-Wei, LI Wei, CHEN Nai-Fei, WANG Guan-Jun

(Tumor Center,First Hospital,Jilin University,Changchun 130021,China)

Received:2009-09-23 Online:2010-05-28 Published:2010-05-28

摘要/Abstract

摘要：

目的：观察三氧化二砷（ATO）联合全反式维甲酸(ATRA)诱导治疗初治急性早幼粒细胞白血病（APL）的疗效，分析联合诱导治疗下影响初治APL疗效的预后因素。方法：将联合应用ATO和ATRA治疗的107例初治APL患者，根据危险因素分层、形态学差异、融合基因和染色体的不同分别分为高危组、中危组、低危组，粗颗粒组(M3a)、细颗粒组(M3b)，融合基因长型组（L+）组、融合基因短型（S +）组，典型核型组、附加核型组，比较治疗过程中各组早期死亡率及治疗后各组患者血液学完全缓解(CR)率及达CR时间，确定影响疗效的预后因素。结果：①107例患者，10例早期死亡，早期病死率为9.35%，最常见不良反应为凝血功能异常及白细胞增多。②高危组达CR时间、CR率和早期病死率与中危和低危组比较差异有显著性（P＜0.05），而低危与中危组比较差异无显著性（P>0.05）；M3b组较M3a组达CR时间明显延长，但两者CR率差异无显著性（P>0.05）；融合基因（L＋）组CR率高于融合基因（S＋）组，达CR时间短于后者（P＜0.05）；典型核型组和附加核型组CR率、达CR时间差异均无显著性（P>0.05）。结论： ATO和ATRA联合诱导治疗，初诊APL患者白细胞计数、形态学分型和分子生物学分型可能是影响CR的因素，而附加染色体异常对短期CR无明显影响。

关键词: 急性早幼粒细胞白血病；砷剂；维甲酸；联合治疗；预后因素

Abstract:

Abstract:Objective
To observe the therapeutic effect of arsenic trioxide(ATO) in combination with all-trans retinoic acid(ATRA) in treatment of newly diagnosed acute promyelocytic leukemia (APL),and analyze the influencing factors of induction treatment.Methods 107 newly diagnosed APL patients treated by both ATO and ATRA were divided into high risk,medium risk,low risk,coarse granular(M3a),fine granular(M3b),L-type isoform ,S-type isoform typical karytype,additional karyotype groups according to different risk ranks,morphological subtypes，fusion gene types and different chromosome types.The early mortality,complete remission(CR) rate,and CR achieving time of each group were detected,the prognostic factors influencing the therapeutical effect were determined.Results ①10 of all 107 patients died in early stage,the early mortality was 9.35%,the most common adverse reactions were disorder of coagulation and leukocytosis.②High risk group had obvious differences with medium and low risk groups in early mortality,CR rate and CR achieving time(P>0.05),but there was no difference between the latter two groups(P>0.05). M3b group had longer CR achieving time than M3a group,but they had the same CR rate (P>0.05).The CR rate in (L＋) group was higher than that in (S＋) group. Typical karyotype group had the same CR rate (P>0.05) and CR achieving time as the additional karyotype group (P>0.05).
Conclusion Initial WBC count,morphological subtypes,fusion gene types are important influencing factors for CR in patients with newly diagnosed APL treated by ATRA in combination with ATO.However,additional karyotype has little impact on short ter
m CR.

Key words: acute promyelocytic leukemia；arsenic trioxide；all-trans retinoic acid；combination treatment；prognostic factors

中图分类号:

R733.71

杨倩倩, 崔久嵬, 李薇, 陈耐飞, 王冠军. 三氧化二砷联合全反式维甲酸诱导治疗初治急性早幼粒细胞白血病患者疗效的影响因素分析[J]. J4, 2010, 36(3): 558-562.

YANG Qian-Qian, CUI Jiu-Wei, LI Wei, CHEN Nai-Fei, WANG Guan-Jun. Analysis on influencing factors of |induction treatment of |arsenic trioxide in combination |with |all-trans retinoic acid in patients with newly diagnosed acute promyelocytic leukemia[J]. J4, 2010, 36(3): 558-562.