Central Laboratory, the First Affiliated Hospital, Harbin Medical University, Heilongjiang, China.
Cancer. 2013 Jan 1;119(1):115-25. doi: 10.1002/cncr.27650. Epub 2012 Aug 28.
The prognosis of acute promyelocytic leukemia (APL) in the elderly is poorer than that of younger patients after treatment with all-trans retinoic acid plus chemotherapy, which is the current standard therapy for APL. A significantly higher mortality during consolidation therapy was found, which is mainly due to deaths from sepsis following chemotherapy-induced myelosuppression.
A total of 33 patients aged 60 years or older with de novo APL were treated with single-agent arsenic trioxide (ATO) for remission induction and postremission therapy. The postremission therapy continued for up to 4 years.
Twenty-nine patients (87.9%) achieved a hematologic complete remission, and the most common adverse event during remission induction was leukocytosis (63.6%). Definite differentiation syndrome was observed in 5 patients. Nonhematologic adverse events were all manageable and reversible. Twenty-eight patients proceeded to postremission therapy. Adverse effects during postremission therapy were mild, transient, and no treatment was required. No patients died from ATO-related toxicities. With a median follow-up of 99 months, the 10-year cumulative incidence of relapse, overall survival, disease-free survival, and cause-specific survival were 10.3%, 69.3%, 64.8%, and 84.8%, respectively, which are comparable with those in the younger APL partners. No significant risks for development of chronic arsenicosis or second malignancy were observed during the follow-up period.
The results indicate that the single-agent ATO regimen is safe and effective with long-term durable remission, and could be used as first-line treatment for elderly patients with de novo APL.
与全反式维甲酸联合化疗相比，老年急性早幼粒细胞白血病（APL）患者在接受治疗后的预后较差，这是目前治疗 APL 的标准疗法。在巩固治疗期间发现死亡率明显更高，这主要是由于化疗引起的骨髓抑制后败血症导致的死亡。
共对 33 名 60 岁或以上的初治 APL 患者采用单药三氧化二砷（ATO）进行缓解诱导和缓解后治疗。缓解后治疗最长持续 4 年。
29 名患者（87.9%）达到血液学完全缓解，缓解诱导期间最常见的不良事件是白细胞增多（63.6%）。5 名患者出现明确的分化综合征。非血液学不良事件均为可管理和可逆的。28 名患者接受缓解后治疗。缓解后治疗期间的不良反应轻微、短暂，无需治疗。没有患者因 ATO 相关毒性而死亡。中位随访 99 个月后，10 年累积复发率、总生存率、无病生存率和特异性生存率分别为 10.3%、69.3%、64.8%和 84.8%，与年轻的 APL 患者相当。在随访期间，未观察到发生慢性砷中毒或第二恶性肿瘤的显著风险。
结果表明，单药 ATO 方案安全有效，长期缓解持久，可作为初治老年 APL 患者的一线治疗方法。
