Shin Ho-Jin, Chung Joo Seop, Choi Young Jin, Cho Goon Jae
Division of Hematology-Oncology, Department of Internal Medicine, Pusan National University Hospital, College of Medicine, Pusan National University, Busan, Korea.
Am J Clin Oncol. 2009 Jun;32(3):227-32. doi: 10.1097/COC.0b013e3181844d2e.
Priming with granulocyte macrophage colony-stimulating factor (GM-CSF) plus all-trans retinoic acid (ATRA) during induction chemotherapy may enhance response rates and survival in patients with acute myeloid leukemia (AML) due to the differentiation of human myeloblastic leukemia cells into granulocytes.
GM-CSF was administered to patients during induction chemotherapy and ATRA was ingested orally on days 1 to 14. Patients undergoing a regimen with GM-CSF and ATRA were evaluated as compared with a historical control group of subjects.
For patients enrolled in this study, the complete remission plus complete remission with incomplete platelet recovery rate was 61.5% as compared with 41.4% for the historical control group of subjects. The relapse rate was 38.5% and 44.8% for the study and control group of subjects, respectively. Two-year probabilities were 45.5% (study group) and 47.4% (control group) for disease-free survival and 38.5% (study group) and 36.2% (control group) for overall survival. The most frequent side effects included fever, headache, and skin lesions with pruritus and dyspnea with pulmonary congestion, similar to ATRA syndrome.
Priming with GM-CSF plus ATRA during anthracycline-based chemotherapy is feasible in terms of response rate, but the toxicity of the regimen is significant.
在诱导化疗期间用粒细胞巨噬细胞集落刺激因子（GM-CSF）加全反式维甲酸（ATRA）进行预处理，可能会提高急性髓系白血病（AML）患者的缓解率和生存率，这是因为人髓母细胞白血病细胞可分化为粒细胞。
在诱导化疗期间给患者使用GM-CSF，并在第1至14天口服ATRA。将接受GM-CSF和ATRA治疗方案的患者与一个历史对照组进行比较评估。
对于本研究纳入的患者，完全缓解加血小板未完全恢复的完全缓解率为61.5%，而历史对照组为41.4%。研究组和对照组患者的复发率分别为38.5%和44.8%。无病生存的两年概率在研究组为45.5%，对照组为47.4%；总生存的两年概率在研究组为38.5%，对照组为36.2%。最常见的副作用包括发热、头痛、伴有瘙痒的皮肤病变以及伴有肺充血的呼吸困难，类似于ATRA综合征。
在基于蒽环类药物的化疗期间用GM-CSF加ATRA进行预处理，在缓解率方面是可行的，但该治疗方案的毒性很大。
