[急性早幼粒细胞白血病患者的长期治疗结果]

[Long-term therapeutic outcome of patients with acute promyelocytic leukemia].

作者信息

Zhang Li, Li Rui, Li Da-peng, Liu Yong-ze, Xu Shi-cai, Hao Yu-shu, Xiao Zhi-jian

机构信息

State Key Laboratory of Experimental Hematology, Institute of Hematology and Blood Diseases Hospital, CAMS and PUMC, Tianjin 300020, China.

出版信息

Zhonghua Xue Ye Xue Za Zhi. 2007 Jan;28(1):15-8.

PMID:17649719

Abstract

OBJECTIVE

To analyze the long-term therapeutic outcome of patients with acute promyelocytic leukemia(APL).

METHODS

Newly diagnosed APL patients were treated with ATRA as induction therapy followed by 3-4 courses of combined consolidation chemotherapy and 2 year maintenance therapy with ATRA and 6-MP + methrotrexate, alternatively. Patients were regularly monitored with nested RT-PCR for PML-RARalpha fusion transcript at the end of consolidation chemotherapy and in the following 4 to 5 years.

RESULTS

A total of 81 patients with APL were entered the trial, 75 (92.6%) patients achieved CR. Early death (ED) rate was 6.6%. ED patients had significantly higher WBC count and higher percentage of peripheral promyelocyte than those achieved CR. Of 65 patients received consolidation, 60 (92.3%) were proved PML-RARalpha fusion gene negative at the end of the 3rd courses and 3 (4.6%) the end of the 4th courses of consolidation. The mean follow-up was 21.2 (8-64) months, 6 patients relapsed (relapse rate 9.2%). The 5-year Kaplan-Meier estimates of overall survival (OS) rate was (86.6 +/- 4.6)%. For 65 patients received consolidation therapy, the 5-year relapse-free survival (RFS) rate was 82.7%. COX-regression analyses showed only high WBC count (>10 x 10(9)/L) had an adverse prognostic influence on OS.

CONCLUSION

More than 80% of APL patients treated with systemic therapy could experience long-term relapse-free survival.

摘要

目的

分析急性早幼粒细胞白血病（APL）患者的长期治疗效果。

方法

初诊APL患者接受全反式维甲酸（ATRA）诱导治疗，随后进行3 - 4个疗程的联合巩固化疗，并交替采用ATRA与6 - 巯基嘌呤（6 - MP）+甲氨蝶呤进行2年维持治疗。在巩固化疗结束时及随后4至5年，定期采用巢式逆转录聚合酶链反应（RT - PCR）监测患者的PML - RARα融合转录本。

结果

共有81例APL患者进入试验，75例（92.6%）患者达到完全缓解（CR）。早期死亡率为6.6%。早期死亡患者的白细胞计数及外周早幼粒细胞百分比显著高于达到CR的患者。65例接受巩固治疗的患者中，60例（92.3%）在第3疗程结束时PML - RARα融合基因检测为阴性，3例（4.6%）在第4疗程结束时检测为阴性。平均随访时间为21.2（8 - 64）个月，6例患者复发（复发率9.2%）。5年总生存（OS）率的Kaplan - Meier估计值为（86.6±4.6）%。对于65例接受巩固治疗的患者，5年无复发生存（RFS）率为82.7%。COX回归分析显示，仅白细胞计数高（>10×10⁹/L）对OS有不良预后影响。