论文部分内容阅读
背景与目的:三氧化二砷(arsenictrioxide,As2O3)治疗急性早幼粒细胞白血病作用机制与全反式维甲酸(all-transretinonicacid,ATRA)有所不同,前者主要是加速细胞的凋亡,后者是诱导细胞的分化。但两者均能抑制急性早幼粒细胞白血病组织因子(tissuefactor,TF)mRNA的转录,降低TF水平和促凝活性,从而改善患者的出凝血异常。本研究旨在探讨两药联合应用能否提高疗效及是否加重不良反应。方法:采用历史对照分组。2000年1月～2001年10月的22例急性早幼粒细胞白血病作为ATRA组,其中初治17例,复发5例;单用ATRA治疗,剂量为25mg/(m2·d),分两次口服,一个疗程最长不超过50天。2001年11月～2003年6月的急性早幼粒细胞白血病19例为联合治疗组,其中初治15例,复发4例,采用As2O3与ATRA联合治疗。治疗剂量为0.1%As2O3溶液10ml,加入5%葡萄糖溶液中静脉滴注,每天1次,持续4～6h,28天为一疗程,ATRA的剂量用法同前组。结果:ATRA治疗组22例中19例(初治16例,复发3例)获完全缓解,完全缓解率为86.4%。联合治疗组19例中17例(初治15例,复发2例)获完全缓解,缓解率为89.5%。病死率ATRA组为18.6%,共3例(1例初治,2例复发);联合治疗组为10.5%,共2例(均为复发者)。完全缓解率和病死率两组比较无统计学差异(P>0.05)。达到完全缓解的中位时间,AT
BACKGROUND & OBJECTIVE: Arsenictrioxide (As2O3) has a different mechanism of action in treating acute promyelocytic leukemia than all-transretinonic acid (ATRA). The former mainly accelerates the apoptosis of cells and the latter induces cells Differentiation. However, both of them can inhibit the transcription of tissue factor (TF) mRNA in acute promyelocytic leukemia, reduce the level of TF and promote procoagulant activity, so as to improve the patient’s coagulation abnormalities. The purpose of this study was to explore whether the combined use of two drugs can improve the efficacy and whether to aggravate the adverse reactions. Method: Using historical control grouping. From January 2000 to October 2001, 22 cases of acute promyelocytic leukemia as ATRA group, of which 17 cases of initial treatment, 5 cases of recurrence; ATRA alone treatment, the dose of 25mg / (m2 · d), in two Oral, a course of no more than 50 days. Nineteen patients with acute promyelocytic leukemia from November 2001 to June 2003 were treated with combination therapy of As2O3 and ATRA. Among them, 15 were newly diagnosed and 4 were relapsed. Therapeutic dose of 0.1% As2O3 solution 10ml, 5% glucose solution by adding intravenous drip once daily for 4 ~ 6h, 28 days for a course of treatment, the dose of ATRA dose with the former group. Results: ATRA treatment group of 22 cases in 19 cases (initial treatment of 16 cases, 3 cases of recurrent) were completely relieved, the complete remission rate was 86.4%. In the combined treatment group, 17 cases (initial treatment 15 cases, recurrent 2 cases) were completely relieved, the remission rate was 89.5%. The mortality rate was 18.6% in the ATRA group (3 cases). One case was naïve and two cases relapsed. The combined treatment group (10.5%) had two cases (all were relapsed). There was no significant difference between the two groups in complete remission rate and mortality (P> 0.05). Median time to complete remission, AT