Department of Medicine, University of Hong Kong, Hong Kong, China.
Department of Medicine, Tuen Mun Hospital, Hong Kong, China.
Cancer. 2019 Sep 1;125(17):3001-3012. doi: 10.1002/cncr.32180. Epub 2019 May 15.
Strategies using oral arsenic trioxide (As O ) are efficacious in relapsed acute promyelocytic leukemia (APL), but they have not been examined in newly diagnosed cases.
Sixty-two consecutive patients (24 men and 38 women) with a median age of 52 years (range, 22-85 years), 36% of whom had high-risk features, underwent induction with all-trans retinoic acid at 45 mg/m /d, oral As O at 10 mg/d, and ascorbic acid at 1 g/d (the all-trans retinoic acid-arsenic trioxide-ascorbic acid [AAA] regimen) for 6 weeks (with patients younger than 70 years additionally receiving daunorubicin at 50 mg/m /d × 3); they then underwent consolidation with 2 monthly cycles of daunorubicin (50 mg/m /d × 2) and cytarabine (100 mg/m /d × 5) and received AAA maintenance (2 weeks every 8 weeks) for 2 years. A contemporaneous cohort of 37 newly diagnosed patients (15 men and 22 women) with a median age of 51 years (range, 23-78 years), not consenting to oral As O induction but receiving similar induction, consolidation, and AAA maintenance, served as a comparator group; 46% of these patients had high-risk features.
The oral As O induction cohort showed a complete remission (CR) rate of 100%. After a median of 37 months (range, 13-82 months), there were no relapses, so conventional risks (age, leukocyte and platelet counts, and Fms-like tyrosine kinase 3 [FLT3] mutations) were not relevant. The leukemia-free survival (LFS) and overall survival (OS) rates were 100% at 3 years and 94.1% at 5 years. The non-As O induction cohort showed a CR rate of 100%. After a median of 52 months (range, 14-77 months), there were 3 relapses (8%). Comparable patients in the oral As O induction and non-As O induction cohorts showed similar OS, but LFS was significantly superior in the oral As O induction cohort.
The incorporation of oral As O into induction for newly diagnosed APL was safe and decreased relapses.
使用口服三氧化二砷（As₂O₃）的策略在复发性急性早幼粒细胞白血病（APL）中是有效的，但尚未在新诊断的病例中进行检查。
62 例连续患者（24 名男性和 38 名女性），中位年龄为 52 岁（范围为 22-85 岁），其中 36%具有高危特征，接受全反式维甲酸 45mg/m²/d、口服三氧化二砷 10mg/d 和抗坏血酸 1g/d（全反式维甲酸-三氧化二砷-抗坏血酸[AAA]方案）治疗 6 周（年龄小于 70 岁的患者另外接受达那唑 50mg/m²/d×3）；然后接受 2 个周期的巩固治疗，每个周期包括达那唑（50mg/m²/d×2）和阿糖胞苷（100mg/m²/d×5），并接受 2 年的 AAA 维持治疗（每 8 周 2 周）。一组 37 名新诊断的患者（15 名男性和 22 名女性），中位年龄为 51 岁（范围为 23-78 岁），不同意接受口服三氧化二砷诱导，但接受了类似的诱导、巩固和 AAA 维持治疗，作为对照组；其中 46%的患者具有高危特征。
口服三氧化二砷诱导组的完全缓解（CR）率为 100%。中位随访 37 个月（范围 13-82 个月）后，无复发，因此常规风险（年龄、白细胞和血小板计数以及 Fms 样酪氨酸激酶 3 [FLT3]突变）不相关。3 年时无白血病生存（LFS）和总生存（OS）率为 100%，5 年时为 94.1%。非口服三氧化二砷诱导组的 CR 率为 100%。中位随访 52 个月（范围 14-77 个月）后，有 3 例复发（8%）。在口服三氧化二砷诱导组和非口服三氧化二砷诱导组中，具有可比性的患者的 OS 相似，但 LFS 在口服三氧化二砷诱导组中明显更好。
将口服三氧化二砷纳入新诊断的 APL 诱导治疗是安全的，并降低了复发率。
