Department of Hematology and Oncology, University Hospital Mannheim, University of Heidelberg, Mannheim, Germany.
Department of Biomedicine and Prevention, University Tor Vergata, Rome, Italy.
Leukemia. 2015 May;29(5):1084-91. doi: 10.1038/leu.2015.12. Epub 2015 Jan 28.
In 2008, a European registry of relapsed acute promyelocytic leukemia was established by the European LeukemiaNet. Outcome data were available for 155 patients treated with arsenic trioxide in first relapse. In hematological relapse (n=104), 91% of the patients entered complete hematological remission (CR), 7% had induction death and 2% resistance, 27% developed differentiation syndrome and 39% leukocytosis, whereas no death or side effects occurred in patients treated in molecular relapse (n=40). The rate of molecular (m)CR was 74% in hematological and 62% in molecular relapse (P=0.3). All patients with extramedullary relapse (n=11) entered clinical and mCR. After 3.2 years median follow-up, the 3-year overall survival (OS) and cumulative incidence of second relapse were 68% and 41% in hematological relapse, 66% and 48% in molecular relapse and 90 and 11% in extramedullary relapse, respectively. After allogeneic or autologous transplantation in second CR (n=93), the 3-year OS was 80% compared with 59% without transplantation (n=55) (P=0.03). Multivariable analysis demonstrated the favorable prognostic impact of first remission duration ⩾1.5 years, achievement of mCR and allogeneic or autologous transplantation on OS of patients alive after induction (P=0.03, P=0.01, P=0.01) and on leukemia-free survival (P=0.006, P<0.0001, P=0.003), respectively.
2008 年，欧洲白血病网建立了复发急性早幼粒细胞白血病的欧洲登记处。对 155 例接受三氧化二砷治疗的复发患者进行了疗效数据评估。在血液学复发（n=104）中，91%的患者进入完全血液学缓解（CR），7%诱导死亡，2%耐药，27%分化综合征，39%白细胞增多，而在分子复发（n=40）中无死亡或副作用发生。血液学和分子复发的分子（m）CR 率分别为 74%和 62%（P=0.3）。所有骨髓外复发（n=11）患者均进入临床和 mCR。中位随访 3.2 年后，血液学复发的 3 年总生存率（OS）和二次复发累积发生率分别为 68%和 41%，分子复发分别为 66%和 48%，骨髓外复发分别为 90%和 11%。在二次 CR 后进行异基因或自体移植（n=93）的患者中，3 年 OS 为 80%，而未移植（n=55）的患者为 59%（P=0.03）。多变量分析显示，首次缓解持续时间 ⩾1.5 年、达到 mCR 和异基因或自体移植对诱导后存活患者的 OS（P=0.03、P=0.01、P=0.01）和无白血病生存（P=0.006、P<0.0001、P=0.003）均有良好的预后影响。
