Castaigne S, Degos L
Service d'Hématologie, Hôpital André-Mignot, Le Chesnay, France.
C R Seances Soc Biol Fil. 1995;189(4):515-20.
It has been shown in vitro that retinoids and especially all-trans retinoic acid (ATRA) were able to induce maturation of malignant cells from patients with acute promyelocytic leukemia (APL). Clinical studies have confirmed in vitro observations. Oral administration of ATRA is able to induce complete remissions in the majority of APL patients, either treated de novo or after failure of conventional chemotherapy. Complete remission are observed by a differentiation process and ATRA therapy in APL represents the first model of differentiation therapy. The major adverse effect of ATRA treatment is the occurrence in some cases of a "retinoic acid syndrome" associated with rapidly, progressive rise of leukocytes. This syndrome is corrected by the addition of chemotherapy. A progressive acquired resistance appears during ATRA treatment and for this reason post remission chemotherapy is indispensable. The superiority of the combination of ATRA+chemotherapy over chemotherapy alone for the incidence of relapse and for survival duration has been established in a randomized European trail (APL 91).
体外实验表明，维甲酸尤其是全反式维甲酸（ATRA）能够诱导急性早幼粒细胞白血病（APL）患者的恶性细胞成熟。临床研究证实了体外实验的观察结果。口服ATRA能够使大多数初治或传统化疗失败后的APL患者获得完全缓解。通过分化过程可观察到完全缓解，ATRA治疗APL代表了分化治疗的首个模型。ATRA治疗的主要不良反应是在某些情况下出现与白细胞迅速、进行性升高相关的“维甲酸综合征”。通过加用化疗可纠正该综合征。在ATRA治疗期间会出现逐渐获得性耐药，因此缓解后化疗必不可少。在一项欧洲随机试验（APL 91）中已证实，ATRA与化疗联合应用在复发率和生存期方面优于单纯化疗。
