Ma Hongbing, Yang Jing
Hematology Department, West China Hospital, Sichuan University, Chengdu, China.
Acta Haematol. 2015;134(2):101-8. doi: 10.1159/000369242. Epub 2015 Apr 22.
This study aimed to compare the curative effects of the combination therapy of all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO, As₂O₃) with ATRA monotherapy on newly diagnosed acute promyelocytic leukemia (APL).
The studies were retrieved from PubMed, EMBASE, Cochrane Library, ChinaInfo and China National Knowledge Infrastructure (CNKI) databases from the inception to June 20, 2014. Thereafter, the eligible studies were selected based on the predefined criteria, and the literature quality was assessed. The meta-analysis was conducted using Review Manager 5.2 software. The pooled effect size was relative risk (RR) and its 95% confidence interval (CI).
A total of 8 studies containing 480 cases were included, among which 264 were assigned to the ATRA + ATO group and the other 216 to the ATRA group. The meta-analysis showed that ATRA + ATO combination therapy significantly improved the complete remission (CR) rate (RR = 1.09, 95% CI = 1.03-1.16, p = 0.004), decreased the early mortality rate (RR = 0.42, 95% CI = 0.20-0.9, p = 0.03) and relapse rate (RR = 0.17, 95% CI = 0.07-0.42, p < 0.0001), but increased the high risk of liver dysfunction (RR = 2.43, 95% CI = 1.72-3.41, p < 0.00001), comparing with ATRA monotherapy.
The ATRA + ATO combination therapy may be more effective for newly diagnosed APL with a higher CR rate but lower early mortality rate and relapse rate. However, the risks of liver damage should be of concern.
本研究旨在比较全反式维甲酸（ATRA）联合三氧化二砷（ATO，As₂O₃）与ATRA单药治疗新诊断急性早幼粒细胞白血病（APL）的疗效。
检索PubMed、EMBASE、Cochrane图书馆、中国资讯网和中国知网数据库中从建库至2014年6月20日的研究。此后，根据预先设定的标准选择符合条件的研究，并评估文献质量。使用Review Manager 5.2软件进行荟萃分析。合并效应量为相对危险度（RR）及其95%置信区间（CI）。
共纳入8项研究，包含480例患者，其中264例被分配至ATRA + ATO组，另外216例被分配至ATRA组。荟萃分析显示，与ATRA单药治疗相比，ATRA + ATO联合治疗显著提高了完全缓解（CR）率（RR = 1.09，95%CI = 1.03 - 1.16，p = 0.004），降低了早期死亡率（RR = 0.42，95%CI = 0.20 - 0.9，p = 0.03）和复发率（RR = 0.17，95%CI = 0.07 - 0.42，p < 0.0001），但增加了肝功能障碍的高风险（RR = 2.43，95%CI = 1.72 - 3.41，p < 0.00001）。
ATRA + ATO联合治疗可能对新诊断的APL更有效，具有更高的CR率，但早期死亡率和复发率更低。然而，肝损伤风险应引起关注。
