摘要
目的观察Ａｓ２Ｏ３治疗复发急性早幼粒细胞白血病疗效，以及外周血白细胞和骨髓象的动态改变与临床意义。方法复发急性早幼粒细胞白血病２８例，以Ａｓ２Ｏ３注射液１０ｍｇ／ｄ静脉滴注，治疗过程中每周或至评价疗效时进行骨髓检查，监测血常规及凝血纤溶指标和肝、肾功能、ＥＫＧ等变化。对达到完全缓解者进行随访。结果Ａｓ２Ｏ３注射液治疗２８例复发ＡＰＬ，完全缓解２７例。２０例治疗过程中出现白细胞增高（Ａ组），７例白细胞没有显著变化（Ｂ组）。Ａ组患者白细胞达高峰平均时间为９．４±２．９天，高峰持续时间平均为１０．８±４．８天。二组患者在治疗前白细胞计数没有显著差异（为２．５±１．４×１０９／Ｌ和３．８±１．７×１０９／Ｌ，Ｐ＝０．０５５７）。在整个治疗过程中，骨髓未出现增生受抑的情况。尽管有白细胞变化的不同，患者达完全缓解的时间无显著差异（为３２．４±６．５天和２７．６±３．０天，Ｐ＝０．０７５８）。无复发生存率也无显著差异（Ｐ＝０．０５７７）。在毒副反应中，以白细胞增益倍数高者出现的机会多。结论Ａｓ２Ｏ３注射液是治疗对全反式维甲酸治疗无效的急性早幼粒细胞白血病的有效药物，Ａｓ２Ｏ３注射液治疗并不能根除急性早幼粒细胞白血病的恶性?
Objective To evaluate the effectiveness of intranvenous arsenic trioxide (As 2O 3) in the treatment of relapsed acute promyelocytic leukemia(APL) and the dynamic changes of peripheral white blood cells (WBC) and bone marrow myelocytes during treatment. Methods A total of 28 relapsed APL patients were enrolled. 10ml of 0.1% As 2O 3 solution was administered intravenously daily. Bone marrow smear was performed each week and/or at the time of response. Peripheral blood count and parameters of coagulation and fibrinolysis were also measured during the course. Those who were in complete remission (CR) were followed up. Results 27/28 cases were in CR, amone these, 20 had their WBC amplification index (peak/pretreatment)≥2 (group A), and 7<2(group B). The time of reaching WBC peak level was 9.4±2.9 d and lasted 10.8±4.8 d. The ratio of leukemia cells in the bone marrow before and after the treatment showed no statistical difference. During the course, there was absence of bone marrow hypocellularity when approaching CR(32.4±6.5d vs 27.6±3.0d, P =0.0758) and difference in the rate of symptom free survival period between the two groups. The frequency of complications and adverse effects were higher when amplification index increased. Conclusions Intraveanous As 2O 3 is effective in the treatment of relapsed APL unresponsive to all trans retinoic acid (ATRA). Because As 2O 3 solution can not eradicate acute promyelocytic leukemic clone, further investigation to seek for other therapeutic regimen is awaited.
出处
《上海医学》
CAS
CSCD
北大核心
1999年第2期95-98,共4页
Shanghai Medical Journal
关键词
急性
早幼粒细胞性
白血病
骨髓象
三氧化二砷
Intravenous As 2O 3 Acute promyelocytic leukemia White cell count Bone marrow smear Dynamic changes Amplification index Treatment
