Tallman Martin S
Northwestern University Feinberg School of Medicine, Division of Hematology-Oncology, Robert H. Lurie Comprehensive Cancer Center, 676 N St. Clair Street, Suite 850, Chicago, IL 60611, USA.
Best Pract Res Clin Haematol. 2007 Mar;20(1):57-65. doi: 10.1016/j.beha.2006.11.002.
Current treatment for acute promyelocytic leukemia (APL) usually includes an induction phase with all-trans retinoic acid (ATRA) and anthracycline-based chemotherapy, followed by a consolidation phase of anthracycline-based chemotherapy and maintenance therapy with ATRA with or without low-dose chemotherapy for 1-2 years. This treatment strategy results in a high complete remission (CR) rate of about 90% and an overall survival rate of 80%. About 5%-30% of patients relapse, mainly patients with high-risk APL. Relapse at extramedullary sites, which occurs in approximately 3%-5% of patients, is emerging as a new issue. Treatment of relapsed/advanced APL includes the use of arsenic trioxide (ATO), gemtuzumab ozogamicin, and hematopoietic stem cell transplantation. ATO is currently the most effective therapeutic agent in relapsed APL. Hematopoietic stem cell transplantation is becoming a common strategy after achieving remission with ATO. Autologous transplant appears to have a more favorable outcome than allogeneic transplant in this setting, particularly when carried out during second remission, primarily because of significantly higher treatment-related mortality with allogeneic transplants. Allogeneic transplant, however, should be strongly considered for patients who remain molecularly positive. Future directions for APL therapy should include developing agents that can prevent relapse, particularly for high-risk patients. Other future treatment strategies may include use of ATO administered concomitantly or sequentially with chemotherapy, gemtuzumab or FLT-3 inhibitors that may obviate the need for autologous transplantation, and posttransplant maintenance perhaps with FLT-3 inhibitors.
急性早幼粒细胞白血病（APL）的当前治疗通常包括一个诱导期，使用全反式维甲酸（ATRA）和蒽环类化疗药物，随后是蒽环类化疗的巩固期以及使用ATRA进行维持治疗，维持治疗可联合或不联合低剂量化疗，持续1 - 2年。这种治疗策略导致约90%的高完全缓解（CR）率和80%的总生存率。约5% - 30%的患者会复发，主要是高危APL患者。髓外部位复发在约3% - 5%的患者中出现，正成为一个新问题。复发/进展期APL的治疗包括使用三氧化二砷（ATO）、吉妥珠单抗奥唑米星和造血干细胞移植。ATO目前是复发APL中最有效的治疗药物。在使用ATO获得缓解后，造血干细胞移植正成为一种常见策略。在这种情况下，自体移植似乎比异体移植有更有利的结果，特别是在第二次缓解期间进行时，主要是因为异体移植的治疗相关死亡率显著更高。然而，对于分子仍呈阳性的患者，应强烈考虑进行异体移植。APL治疗的未来方向应包括开发能够预防复发的药物，特别是针对高危患者。其他未来治疗策略可能包括同时或序贯使用ATO与化疗、吉妥珠单抗或FLT - 3抑制剂，这可能无需进行自体移植，以及移植后可能使用FLT - 3抑制剂进行维持治疗。
