Martinelli G, Ottaviani E, Testoni N, Visani G, Diverio D, D'Elia G, Mandelli F, Tura S
Institute of Hematology and Medical Oncology Seràgnoli, University of Bologna, Italy.
Haematologica. 1998 Nov;83(11):985-8.
Acute promyelocytic leukemia (APL) (M3 according to FAB classification) is a subtype of acute myelogenous leukemia characterized by a specific t(15;17) (q22;q12) chromosomal translocation. The majority of APL patients achieve morphologic remission after induction chemotherapy. They can be followed from this point by cytogenetic and molecular analysis of the persistence of the PML/RAR alpha transcript. In order to determine the influence of successive courses of consolidation chemotherapy on clinical and molecular outcome, APL patients treated with all-trans retinoic acid (ATRA) and chemotherapy (AIDA-GIMEMA-LAP0493 protocol) were investigated.
Twenty-four APL patients (pts) (15 males; 9 females) were studied by RT-PCR and cytogenetic analysis at diagnosis, after induction chemotherapy, at each point after any of three consolidation courses, and every 3 months during the first years of maintenance therapy. The median follow-up was 24 months (mths) (range 7-40 mths).
All pts achieved hematologic remission after induction chemotherapy. Our results demonstrate that the majority (87%) of APL patients were still molecularly positive for the APL associated transcript after induction chemotherapy, while the majority (80%) of APL patients became PCR-after the second consolidation chemotherapy.
The role of the third consolidation chemotherapy course in converting patients with persistent molecular evidence of disease from PCR+ to PCR- was minimal. We confirm the validity of molecular follow-up after single courses of chemotherapy in monitoring the role of molecular remission.
急性早幼粒细胞白血病（APL）（根据FAB分类为M3）是急性髓系白血病的一种亚型，其特征为特定的t(15;17)(q22;q12)染色体易位。大多数APL患者在诱导化疗后可实现形态学缓解。此后可通过对PML/RARα转录本持续性的细胞遗传学和分子分析对其进行随访。为了确定连续巩固化疗疗程对临床和分子结局的影响，我们对接受全反式维甲酸（ATRA）和化疗（AIDA - GIMEMA - LAP0493方案）治疗的APL患者进行了研究。
对24例APL患者（15例男性；9例女性）在诊断时、诱导化疗后、三个巩固疗程中任何一个疗程后的每个时间点以及维持治疗的头几年每3个月进行一次逆转录聚合酶链反应（RT - PCR）和细胞遗传学分析。中位随访时间为24个月（范围7 - 40个月）。
所有患者在诱导化疗后均实现血液学缓解。我们的结果表明，大多数（87%）APL患者在诱导化疗后APL相关转录本在分子水平上仍为阳性，而大多数（80%）APL患者在第二次巩固化疗后变为PCR阴性。
第三个巩固化疗疗程在将仍有疾病分子证据的患者从PCR阳性转为PCR阴性方面作用极小。我们证实了在单个化疗疗程后进行分子随访在监测分子缓解作用方面的有效性。
