低中危组急性早幼粒细胞白血病患者双诱导治疗后加入细胞毒性药物时机的早期临床分析研究

摘要

Objective After induction therapy in patients with acute promyelocytic leukemia (APL) at a low-to-intermediate risk level,the efficacy and adverse reactions of cytotoxic drugs vary at different WBC levels.Methods Thirty-six patients with newly diagnosed APL admitted to the First Affiliated Hospital of Chongqing Medical University from March 2011 to April 2017 were enrolled and received dual induction therapy of all trans-retinoic acid and arsenic trioxide.With different standards,patients were divided into three groups according to WBCs:(1)(10-20)×109/L group and >20×109/L group;(2)(10-25)×109/L group and >25×109/L group;and (3)(10-30)×109/L group and >30×109/L group.The rate of complete remission (CR),the time required to reach CR,the duration of coagulation dysfunction,and the adverse reactions during the induction period were analyzed in these groups.Results None of the 36 patients died during induction.In the WBC (10-20)×109/L group,the time required for CR was shorter than the time required in the WBC>20×109/L group(P<0.05);however,there was no statistical difference in the CR rate and the duration of coagulation dysfunction between the (10-20) ×109/L group and >20×109/L group(P>0.05).No statistical differences were observed in the CR rate,the time required for CR,and the duration of coagulation dysfunction in the (10-25)×109/L,>25×109/L,(10-30)×109/L,and >30×109/L groups(P>0.05).The average WBC peak in the (10-20)×109/L,(10-25)×109/L,and (10-30)×109/L groups was lower than the >20×109/L,>25×109/L,and >30×109/L groups,respectively.There was no statistical difference regarding the incidence of differentiation syndrome,infections,abnormal liver function,and grade 3-4 myelosuppression among the (10-20) ×109/L,>20×109/L groups,and the (10-25)×109/L,>25×109/L,(10-30)×109/L,and >30×109/L groups(P>0.05). Conclusion After ATO-ATRA double-induction therapy in APL patients in the low-intermediate risk groups,cytotoxic drugs with a WBC of (10-20)×109/L in the peripheral blood achieved a relatively good early curative effect.%目的 比较低中危组急性早幼粒细胞白血病(APL)患者进行双诱导治疗后,在不同外周血白细胞计数(WBC)时予以细胞毒性药物的疗效和不良反应.方法 选取2011年3月—2017年4月重庆医科大学附属第一医院收治的初诊APL患者36例,对其进行全反式维甲酸(ATRA)+三氧化二砷(ATO)双诱导治疗.根据加入细胞毒性药物时外周血WBC,以不同的标准对患者进行分组:(1)(10~20)×109/L组和>20×109/L组;(2) (10~25)×109/L组和>25×109/L组;(3)(10~30)×109/L组和>30×109/L组.分析各组患者完全缓解(CR)率、达CR所需时间、凝血功能异常持续时间,以及诱导期间的不良反应发生情况.结果 36例患者诱导期间无一例死亡.(10~20)×109/L组达CR所需时间短于>20×109/L组(P<0.05);(10~20)×109/L组和>20×109/L组CR率、凝血功能异常持续时间比较,差异均无统计学意义(P>0.05).(10~25)×109/L组和>25×109/L组、(10~30)×109/L组和>30×109/L组CR率、达CR所需时间、凝血功能异常持续时间比较,差异均无统计学意义(P>0.05).(10~20)×109/L组、(10~25)×109/L组、(10~30)×109/L组平均WBC峰值分别低于>20×109/L组、>25×109/L组、>30×109/L组(P<0.05);(10~20)×109/L组和>20×109/L组、(10~25) ×109/L组和>25×109/L组、(10~30)×109/L组和>30×109/L组分化综合征(DS)发生率、感染发生率、肝功异常率、3~4级骨髓抑制发生率比较,差异均无统计学意义(P>0.05).结论 低中危组APL患者进行ATRA-ATO双诱导治疗后,外周血WBC在(10~20)×109/L时加用细胞毒性药物可获得相对较佳的早期疗效.