摘要
目的:研究难治或复发性急性早幼粒细胞白血病(APL)不同诱导缓解方案的疗效,诱导缓解后不同巩固维持治疗方案对预后和生存率的影响。方法:APL57例(包括初次诱导未缓解与第1次复发的APL),按照不同的诱导缓解治疗方案分组(含砷剂组:单用亚砷酸组及亚砷酸加全反式维甲酸(ATRA)联合治疗组;不含砷剂组:单用化疗组)比较各组的完全缓解率(CR)和达到CR的时间;按照不同的缓解后治疗方案分组(亚砷酸/全反式维甲酸/化疗序贯治疗组;化疗组)比较各组复发率、总生存率(OS)、无病生存率(DFS)。采用SPSS10.0软件进行统计学分析(χ2检验、t检验、MannWhitney检验、Kaplan-Meier生存曲线、Log-Rank检验)。结果:含砷剂(亚砷酸)组诱导CR率可达80,明显高于不含亚砷酸组CR率(61.4±9.04)(P<0.05);含砷剂组达到CR时间(36.36±9.56)d,较不含亚砷酸组(47.26±22.21)d显著缩短(P<0.01)。诱导缓解后的治疗对生存影响显著,全反式维甲酸、亚砷酸、蒽环类化疗序贯治疗组复发率9.0,低于化疗组38.9(P<0.05)。序贯治疗组1年、3年生存率是(74.56±4.57)、(60.09±4.64),而化疗组1年、3年生存率仅为(57.84±8.01)、(49.13±13.14)(P<0.05)。序贯治疗组的3年DFS(71.48±1.94),显著高于化疗组的DFS(51.32±13.72)(P<0.05)。结论:含有亚砷酸诱导缓解方案诱导缓解率高,达CR时间短。全反式维甲酸、亚砷酸、蒽环类化疗序贯治疗复发率低,长期生存率高。监测PML/RARa融合基因对提示复发和调整治疗有重要意义。
Objective：To analyze the complete remission rate and long-term survival of different induction regimens and post-remission therapy in patients with adult refractory or relapsed acute promyelocytic leukemia. Method：We retrospectively analyzed refractory or relapsed acute promyelocytic leukemia cases in our hospital, and compared the complete remission （CR） rate among groups of different induction regimens. We also compared the relapse rate, overall survival （OS） and disease free survival （DFS） among different post-remission therapy groups. χ^2 test, t test and Mann whitney test, Kaplan-Meier survival curve and Log-Rank test were used for statistics analysis. Result： The induction regimens including Arsenic Trioxide （ATO） had complete remission （CR） rate of 80 %, compared with the regimens without ATO（ 61.4 ± 9.04 %, P 〈0.05）. Patients with ATO regimen got complete remission faster （36.36±9.56 days） than those with regimens without ATO （47.26± 22.21 days） （ P 〈0.05）. Aher getting CR, post-remission therapy was an important prognostic factor of long-term survival. The group of post-remission treatment combining with ATRA, ATO and chemotherapy sequentially had a relapse rate （9.0%） lower than chemotherapy （38.9%）（ P 〈0.05）. The 1-year, 3-years cumulated survival rate of the sequential therapy were （74.56±4.57）% and （60.09±4.64）% ,respectively. The chemotherapy group had 1 year, 3-year survival rate of （57.84 ± 8.01 ） %, （ 49. 13 ± 13. 14） %（ P 〈 0.05 ）. 3-years DFS of sequential therapy group was higher（71. 48±1.94%）than that of chemotherapy group （51.32±13.72%） （ P 〈0.05）. Conclusion： The regimens including ATO would increase CR rate , shorten the period to CR. The post-remission treatment combining with ATRA, ATO and chemotherapy sequentially had a low relapse rate, and would significantly improve the long-term survival of APL patients. Continuous detection of PML/RARa fusion transcripts is important for predicting hematological relapse and may direct the therapy.
出处
《临床血液学杂志》
CAS
2008年第6期572-574,共3页
Journal of Clinical Hematology
