论文部分内容阅读
目的:观察三氧化二砷(ATO)联合全反式维甲酸(ATRA)诱导治疗初治急性早幼粒细胞白血病(APL)的疗效,分析联合诱导治疗下影响初治APL疗效的预后因素。方法:将联合应用ATO和ATRA治疗的107例初治APL患者,根据危险因素分层、形态学差异、融合基因和染色体的不同分别分为高危组、中危组、低危组,粗颗粒组(M3a)、细颗粒组(M3b),融合基因长型组(L+)组、融合基因短型(S+)组,典型核型组、附加核型组,比较治疗过程中各组早期死亡率及治疗后各组患者血液学完全缓解(CR)率及达CR时间,确定影响疗效的预后因素。结果:①107例患者,10例早期死亡,早期病死率为9.35%,最常见不良反应为凝血功能异常及白细胞增多。②高危组达CR时间、CR率和早期病死率与中危和低危组比较差异有显著性(P<0.05),而低危与中危组比较差异无显著性(P>0.05);M3b组较M3a组达CR时间明显延长,但两者CR率差异无显著性(P>0.05);融合基因(L+)组CR率高于融合基因(S+)组,达CR时间短于后者(P<0.05);典型核型组和附加核型组CR率、达CR时间差异均无显著性(P>0.05)。结论:ATO和ATRA联合诱导治疗,初诊APL患者白细胞计数、形态学分型和分子生物学分型可能是影响CR的因素,而附加染色体异常对短期CR无明显影响。
OBJECTIVE: To observe the therapeutic effect of ATRA combined with all-trans retinoic acid (ATRA) on the treatment of newly diagnosed acute promyelocytic leukemia (APL) and to analyze the prognostic factors of the APL efficacy under combined induction therapy. Methods: A total of 107 newly diagnosed APL patients treated with combination of ATO and ATRA were divided into high risk group, moderate risk group, low risk group, coarse particle group according to risk stratification, morphological differences, fusion gene and chromosome. (M3a), M3b, L +, S +, karyotype and additional karyotype. The mortality of each group was compared with that of the control group After treatment, hematologic complete remission (CR) rate and CR time of each group were determined, and prognostic factors influencing curative effect were determined. Results: ① In 107 patients, 10 patients died early and the early mortality rate was 9.35%. The most common adverse reactions were coagulation dysfunction and leukocytosis. ② The risk of CR, CR and early mortality in high risk group were significantly different from those in intermediate risk and low risk group (P <0.05), but there was no significant difference between low risk and intermediate risk group (P> 0.05); M3b (P> 0.05). The CR rate of the fusion gene (L +) group was higher than that of the fusion gene (S +) group, the CR time was shorter than the latter P <0.05). There was no significant difference in CR rate and CR time between the typical karyotype group and the additional karyotype group (P> 0.05). Conclusions: The combination of ATO and ATRA induces the treatment of newly diagnosed APL patients with leukocyte count, morphological typing and molecular biological typing may be the factors that affect CR, while additional chromosomal abnormalities have no significant effect on short-term CR.