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目的观察全反式维甲酸(ATRA)与亚砷酸(ATO)联合化疗对急性早幼粒细胞白血病(APL)患者的疗效。方法回顾性分析86例不同危险分级的初治APL患者的临床资料。根据治疗前白细胞和血小板数将APL患者分为低、中、高危三组。采用ATRA+ATO+蒽环类药诱导缓解,蒽环类药+阿糖胞苷巩固治疗,ATRA+ATO+甲氨蝶呤(MTX)[部分加用6-巯基嘌呤(6-MP)]维持治疗。结果治疗后,完全缓解(CR)率高达95.3%(82/86)。中位随访37个月,高危组和中低危组无事件生存率及中枢神经系统累积复发率差异均无统计学意义(P>0.05)。维持治疗单用MTX者或MTX+6-MP者CR率均为100%。结论 APL患者尤其是高危患者可以从ATO+ATRA+化疗中受益;该方案作为初治APL的一线治疗方案优势明显。
Objective To investigate the efficacy of all-trans retinoic acid (ATRA) combined with arsenious acid (ATO) in patients with acute promyelocytic leukemia (APL). Methods The clinical data of 86 newly diagnosed APL patients with different risk grades were retrospectively analyzed. APL patients were divided into low, medium and high risk groups according to the number of leucocytes and platelets before treatment. ATRA + ATO + anthracycline was used to induce remission. Anthracyclines + cytarabine consolidation therapy, and ATRA + ATO + methotrexate (MTX) [plus 6-mercaptopurine (6-MP) Results After treatment, the rate of complete remission (CR) was as high as 95.3% (82/86). There was no significant difference in event-free survival rate and cumulative central nervous system recurrence rate between high-risk group and middle-low risk group at the median follow-up of 37 months (P> 0.05). The CR rates for maintenance MTX alone or MTX + 6-MP were 100%. Conclusion Patients with APL, especially those at high risk, may benefit from ATO + ATRA + chemotherapy; this regimen has clear advantages as a first-line regimen for first-line APL.