摘要
目的探讨原发高白细胞型急性早幼粒细胞白血病(APL)的临床特点及有效的治疗方法。方法回顾性分析1993年10月至2006年8月苏州大学附属第一医院收治的66例原发高白细胞型APL患者和152例非高白细胞型APL患者的临床资料,并对高白细胞型患者按治疗方案的不同进行了分组比较。结果高白细胞组APL患者早期病死率、弥散性血管内凝血(DIC)和维甲酸综合征(RAS)发生率分别为30.3%,57.6%和31.8%,均高于非高白细胞组(7.2%,38.1%和21.1%)(P<0.05),而完全缓解(CR)率较低(63.6%对88.2%)(P<0.05)。高白细胞组患者中61例接受了诱导治疗,其中31例单用维甲酸治疗,21例维甲酸联合亚砷酸治疗,9例单用亚砷酸治疗,各组早期病死率分别为27.3%,14.3%和55.6%,CR率分别为67.7%,81.0%和44.4%。61例患者中41例在接受诱导分化治疗的同时加用化疗,其CR率为80.5%,总病死率为19.5%;而未加用化疗的20例患者其CR率为45.0%,总病死率为55.0%,两组比较差异有显著性意义(P<0.05)。结论原发高白细胞型APL较非高白细胞型APLCR率低,早期病死率高,DIC、RAS发生率高。维甲酸加亚砷酸双诱导并联合小剂量化疗是治疗高白细胞型APL的最有效的方案,可明显减少早期病死率,提高CR率。
Objective To investigate the clinical features and the efficient therapy of acute promyelocytic leukemia （APL） with high initial white blood cell （WBC）count. Methods The clinical features of 66 newly diagnosed APL patients with high initial WBC and 152 patients without high initial WBC from the First Affiliated Hospital of Soochow University between October 1993 and August 2006 were retrospectively analyzed. Additionally, 66 patients with high WBC were divided into different groups according to the different induction therapy and the therapeutic effects were compared. Results The early death rate and the incidence of disseminated intravascular coagulation （DIC） and retinoic acid syndrome（RAS） were 30.3% ,57.6% and 31.8% respectively for the group with high initial WBC ,which were higher than the indexes of 7.2% ,38.1% and 21.05% respectively for the group without high initial WBC（P〈0.05） ,whereas CR rate（63.6% ）for the group with high initial WBC was lower than that（88.2%）for the group without high initial WBC （P〈0.05）. Sixty-one of 66 patients with high WBC accepted induction therapy：31 patients were treated with all-trans retinoic acid （ATRA）alone ,21 patients with the combination of ATRA and arsenic trioxide（ ATO ） ,9 with ATO alone, the early death rates were 27.3% ,14. 3% ,55.6% respectively;CR rates were 67.7% ,81.0% ,44.4% respectively. Of 61 patients ,41 cases were given low-dose chemotherapy, the CR rate was 80.5% ,total death rate was 19. 5% ,that of 20 patients without chemotherapy were 45.0% ,55.0% respectively. The differences between two groups had statistical significance（P〈0.05 ）. Conclusion Compared with APL without high initial WBC ,APL with high initial WBC has lower CR rate, higher early death rate, higher incidence of DIC and RAS. The combination of ATRA,ATO and chemotherapy is the most efficient therapeutic approach to APL patients with high initial WBC, which can significantly reduce the early deathrate and improve the CR rate.
出处
《中国实用内科杂志》
CAS
CSCD
北大核心
2007年第20期1607-1609,共3页
Chinese Journal of Practical Internal Medicine
关键词
白血病
早幼粒细胞
急性
临床特征
治疗
Promyelocytic, leukemia, acute
Clinical features
Therapy
