Crespo-Solis Erick, Contreras-Cisneros Jorge, Demichelis-Gómez Roberta, Rosas-López Adriana, Vera-Zertuche Juan Mauricio, Aguayo Alvaro, López-Karpovitch Xavier
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico.
Instituto Nacional de Ciencias Médicas y Nutrición Salvador Zubirán (INCMNSZ), Ciudad de México, Mexico.
Rev Bras Hematol Hemoter. 2016 Oct-Dec;38(4):285-290. doi: 10.1016/j.bjhh.2016.08.002. Epub 2016 Sep 21.
Acute promyelocytic leukemia has good prognosis in view of the high complete remission and survival rates achieved with therapies containing all-trans retinoic acid or arsenic trioxide. However, there is a significant risk of death during induction due to hemorrhage secondary to disseminated intravascular coagulation. This has contributed to a gap in the prognosis of patients between developed and developing countries. The International Consortium on Acute Promyelocytic Leukemia was created in 2005 and proposed a treatment protocol based on daunorubicin and all-trans retinoic acid stratified by risk geared toward developing countries. Herein are presented the results from the first patient cohort treated in a single developing country hospital employing a slightly modified version of the International Consortium protocol in a real life setting. Twenty patients with acute promyelocytic leukemia were enrolled: 27.8% had low-risk, 55.6% intermediate risk and 16.7% high-risk. The complete remission rate was 94.4% after a median of 42 days. Both relapse rates and death rates were one patient (5.5%) each. No deaths were observed during consolidation. After a median follow-up of 29 months, the overall survival rate was 89.1%. Efficacy and safety of the International Consortium on Acute Promyelocytic Leukemia protocol has been reproduced in acute promyelocytic leukemia patients from a developing country.
鉴于含全反式维甲酸或三氧化二砷的治疗方案能实现较高的完全缓解率和生存率，急性早幼粒细胞白血病的预后良好。然而，诱导治疗期间因弥散性血管内凝血继发出血导致死亡的风险很大。这造成了发达国家和发展中国家患者预后的差距。急性早幼粒细胞白血病国际联盟于2005年成立，并提出了一种基于柔红霉素和全反式维甲酸的治疗方案，该方案根据风险进行分层，面向发展中国家。本文介绍了在一家发展中国家医院对首批患者队列采用国际联盟方案的略微修改版本在实际临床环境中治疗的结果。纳入了20例急性早幼粒细胞白血病患者：27.8%为低风险，55.6%为中风险，16.7%为高风险。中位42天后完全缓解率为94.4%。复发率和死亡率均为1例患者（5.5%）。巩固治疗期间未观察到死亡。中位随访29个月后，总生存率为89.1%。急性早幼粒细胞白血病国际联盟方案的疗效和安全性在一个发展中国家的急性早幼粒细胞白血病患者中得到了重现。
