Ma R J, Zhu Z M, Yuan X L, Jiang L, Yang S W, Yang J, Guo J M, Zhang L, Lei P C, Wang Z, Zang Y Z, Chen Y Q, Wang T B, Kong D, Sun K, Zhang Y
Department of Hematology, Henan Provincial People's Hospital, Zhengzhou 450003, China.
Zhonghua Xue Ye Xue Za Zhi. 2017 Jun 14;38(6):523-527. doi: 10.3760/cma.j.issn.0253-2727.2017.06.011.
To explore the efficacies of regimens of three-drug induction therapy (ATRA+ATO+anthracyclines) versus two-drug induction therapy (ATRA+ATO) in patients with acute promyelocytic leukemia (APL). Of 184 patients diagnosed with APL from January 2009 to March 2016, 58 patients underwent three-drug induction therapy, while the rest were treated with two-drug induction therapy. Three-drug induction therapy was of ATRA (20 mg·m(-2)·d(-1), d(1-28)) + ATO (0.16 mg·kg(-1)·d(-1), d(1-28)) + Idarubicin (8 mg·m(-2)·d(-1), d(3-5)) /daunorubicin (40 mg·m(-2)·d(-1), d(3-5)) , while two-drug induction therapy ATRA+ATO with the same doses and methods as above. Of 184 cases, 69 cases accompanied with WBC counts>10×10(9)/L, 115 cases with WBC counts≤10×10(9)/L at onset. ①Short-term efficacy: After one cycle induction therapy, the rates of hematologic remission, genetic remission, molecular remission and induced differentiation syndrome (DS) in three-drug regimen group were 98.3%, 87.9%, 72.4% and 0 respectively, while those in two-drug regimen group were 87.3%, 65.9%, 51.6% and 12.7% respectively. In patients with WBC >10×10(9)/L, DS rate and early mortality in three-drug regimen group were lower than in two-drug regimen group (0 15.6%, 4.2% 15.6%, respectively). In patients with WBC≤10×10(9)/L, DS rate in three-drug regimen group was also lower than in two-drug regimen group (0 12.3%) , but there were no statistical differences in terms of relapse and early mortality. ② Long-term efficacy: The relapse rate, overall survival (OS) and disease free survival (DFS) in three-drug regimen group were 0, 98.5%, 96.6% respectively, while those in two-drug regimen group were 8.6%, 86.5% and 84.1% respectively; the advantages of three-drug over two-drug regimen, especially in cases of WBC >10×10(9)/L were observed. ③ Side effects: the incidences of gastrointestinal reaction, liver dysfunction, myocardial damage and headache in three-drug regimen group hardly increased. The efficacies of three-drug induction therapy were superior to two-drug one.
探讨三药诱导治疗方案（全反式维甲酸+三氧化二砷+蒽环类药物）与两药诱导治疗方案（全反式维甲酸+三氧化二砷）对急性早幼粒细胞白血病（APL）患者的疗效。在2009年1月至2016年3月确诊的184例APL患者中，58例接受三药诱导治疗，其余患者接受两药诱导治疗。三药诱导治疗方案为全反式维甲酸（20mg·m⁻²·d⁻¹，第1 - 28天）+三氧化二砷（0.16mg·kg⁻¹·d⁻¹，第1 - 28天）+伊达比星（8mg·m⁻²·d⁻¹，第3 - 5天）/柔红霉素（40mg·m⁻²·d⁻¹，第3 - 5天），两药诱导治疗方案为全反式维甲酸+三氧化二砷，剂量和方法同上。184例患者中，69例起病时白细胞计数>10×10⁹/L，115例起病时白细胞计数≤10×10⁹/L。①短期疗效：诱导治疗1个周期后，三药方案组血液学缓解率、遗传学缓解率、分子学缓解率及诱导分化综合征（DS）发生率分别为98.3%、87.9%、72.4%和0，两药方案组分别为87.3% 、65.9%、51.6%和12.7%。白细胞>10×10⁹/L的患者中，三药方案组DS发生率和早期死亡率低于两药方案组（分别为0对15.6%，4.2%对15.6%）。白细胞≤10×10⁹/L的患者中，三药方案组DS发生率也低于两药方案组（0对12.3%），但复发率和早期死亡率无统计学差异。②长期疗效：三药方案组复发率、总生存率（OS）和无病生存率（DFS）分别为0、98.5%、96.6%，两药方案组分别为8.6%、86.5%和84.1%；观察到三药方案优于两药方案，尤其在白细胞>10×10⁹/L的病例中。③副作用：三药方案组胃肠道反应、肝功能损害、心肌损害及头痛的发生率几乎未增加。三药诱导治疗的疗效优于两药诱导治疗。
