Zhang Ye, Wu SiJing, Luo Dan, Zhou JianFeng, Li DengJu
Department of Hematology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei, China.
PLoS One. 2016 Jan 26;11(1):e0147545. doi: 10.1371/journal.pone.0147545. eCollection 2016.
All-trans retinoic acid combined to anthracycline-based chemotherapy is the standard regimen of acute promyelocytic leukemia. The advent of arsenic trioxide has contributed to improve the anti-leukemic efficacy in acute promyelocytic leukemia. The objectives of the current study were to evaluate if dual induction by all-trans retinoic acid and arsenic trioxide could accelerate the recovery of abnormality of coagulation and fibrinolysis in patients with acute promyelocytic leukemia.
Retrospective analysis was performed in 103 newly-diagnosed patients with acute promyelocytic leukemia. Hemostatic variables and the consumption of component blood were comparably analyzed among patients treated by different induction regimen with or without arsenic trioxide.
Compared to patients with other subtypes of de novo acute myeloid leukemia, patients with acute promyelocytic leukemia had lower platelet counts and fibrinogen levels, significantly prolonged prothrombin time and elevated D-dimers (P<0.001). Acute promyelocytic leukemia patients with high or intermediate risk prognostic stratification presented lower initial fibrinogen level than that of low-risk group (P<0.05). After induction treatment, abnormal coagulation and fibrinolysis of patients with acute promyelocytic leukemia was significantly improved before day 10. The recovery of abnormal hemostatic variables (platelet, prothrombin time, fibrinogen and D-dimer) was not significantly accelerated after adding arsenic trioxide in induction regimens; and the consumption of transfused component blood (platelet and plasma) did not dramatically change either. Acute promyelocytic leukemia patients with high or intermediate risk prognostic stratification had higher platelet transfusion demands than that of low-risk group (P<0.05).
Unexpectedly, adding arsenic trioxide could not accelerate the recovery of abnormality of coagulation and fibrinolysis in acute promyelocytic leukemia patients who received all-trans retinoic acid combining chemotherapy.
全反式维甲酸联合蒽环类化疗是急性早幼粒细胞白血病的标准治疗方案。三氧化二砷的出现有助于提高急性早幼粒细胞白血病的抗白血病疗效。本研究的目的是评估全反式维甲酸和三氧化二砷双重诱导是否能加速急性早幼粒细胞白血病患者凝血和纤溶异常的恢复。
对103例新诊断的急性早幼粒细胞白血病患者进行回顾性分析。对接受不同诱导方案（含或不含三氧化二砷）治疗的患者的止血变量和成分血消耗量进行了比较分析。
与初发急性髓系白血病其他亚型患者相比，急性早幼粒细胞白血病患者血小板计数和纤维蛋白原水平较低，凝血酶原时间显著延长，D-二聚体升高（P<0.001）。高或中危预后分层的急性早幼粒细胞白血病患者初始纤维蛋白原水平低于低危组（P<0.05）。诱导治疗后，急性早幼粒细胞白血病患者的凝血和纤溶异常在第10天前显著改善。诱导方案中加入三氧化二砷后，异常止血变量（血小板、凝血酶原时间、纤维蛋白原和D-二聚体）的恢复未显著加速；输注的成分血（血小板和血浆）消耗量也未显著改变。高或中危预后分层的急性早幼粒细胞白血病患者血小板输注需求高于低危组（P<0.05）。
出乎意料的是，在接受全反式维甲酸联合化疗的急性早幼粒细胞白血病患者中，加入三氧化二砷并不能加速凝血和纤溶异常的恢复。
