Fenaux Pierre, Chevret Sylvie, de Botton Stéphane
Department of Hematology, Paris XIII University, France.
Best Pract Res Clin Haematol. 2003 Sep;16(3):495-501. doi: 10.1016/s1521-6926(03)00044-6.
Only 15 to 20% of acute promyelocytic leukaemia (APL) patients are older than 60 years, and the characteristics and outcome of APL in that age range are not well known. Published studies show that APL in elderly patients has haematological features similar to those of APL in younger patients. However, using the current combination of all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy, the outcome for these patients, although it has much improved, remains less favourable than that for younger patients. This is due to a higher incidence of early deaths and deaths in complete remission (CR), during consolidation chemotherapy courses, whereas the relapse rate appears similar in older and younger adults. Treatment approaches with more limited myelosuppression, especially consolidation chemotherapy with an anthracycline alone (without Ara-C), low-dose maintenance treatment with 6-mercaptopurine, methotrexate and ATRA, and consolidation with arsenic trioxide, should be tested especially in elderly patients in order to replace more toxic 'classical' anthracycline-Ara-C consolidation treatment, after achieving CR with ATRA.
只有15%至20%的急性早幼粒细胞白血病（APL）患者年龄超过60岁，该年龄范围内APL的特征和预后尚不清楚。已发表的研究表明，老年患者的APL具有与年轻患者相似的血液学特征。然而，使用目前全反式维甲酸（ATRA）和蒽环类化疗的联合方案，这些患者的预后虽然有了很大改善，但仍不如年轻患者。这是由于在巩固化疗疗程中，早期死亡和完全缓解（CR）期死亡的发生率较高，而老年和年轻成年人的复发率似乎相似。应特别在老年患者中测试骨髓抑制作用更有限的治疗方法，特别是单独使用蒽环类药物（不使用阿糖胞苷）进行巩固化疗、使用6-巯基嘌呤、甲氨蝶呤和ATRA进行低剂量维持治疗以及使用三氧化二砷进行巩固治疗，以便在使用ATRA达到CR后替代毒性更大的“经典”蒽环类-阿糖胞苷巩固治疗。
