砷剂联合全反式维甲酸诱导治疗急性早幼粒细胞白血病疗效的影响因素分析

摘要

目的:研究三氧化二砷(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,分析影响疗效的预后因素.方法:将联合应用ATO和ATRA治疗的98例初治APL患者,根据年龄、性别、外周血白细胞(WBC)、血清乳酸脱氢酶(LDH)水平、细胞形态学、融合基因和染色体异常等因素的差异分组,比较治疗后各组患者血液学完全缓解(CR)率及达到CR的时间,确定影响疗效的预后因素.结果:98例患者中CR率为89％,达到CR所需的中位时间为30.5(19-42)d.初诊时年龄偏大、WBC数、LDH水平较高,拥有附加染色体核型[除典型的t(15;17) (q22;q21)合并有其他染色体异常]或融合基因的短型(S+)APL患者CR率较低,达到CR的时间较长;而存在t(15;17)(q22;q21)染色体异位或融合基因长型(L+)使CR率明显提高,达到CR时间缩短.结论:初诊时年龄、WBC计数、LDH水平、染色体情况、有无PML/RARα融合基因是影响砷剂联合全反式维甲酸治疗APL患者疗效的重要因素.%Objective: To observe the therapeutic effect of arsenic trioxide (ATO)in combination with all - tran-sretinoic acid (ATRA) in treatment of newly diagnosed acute promyelocytic leukemia (APL) ,and analyze the influ-encing factors of induction treatment. Methods: Total of 98 newly diagnosed APL patients treated by both ATO and ATRA were divided by age,gender,WBC count,LDH,morphological subtypes,fusion gene types and different chromo-some types. Results: In the 98 patients, CR rate was 89% and CR achieving time was 30.5 (19 - 42) d. Older, high-er WBC,LDH higher,S -type isoform typical karytype,additional karyotype groups had the lower CR rate,longer CR achieving time, while with t( 15; 17) (q22 ;q21), L - type isoform typical karytype had the different results. Conclu-sion : Age, initial WBC count, LDH, morphological subtypes, additional karyotype, fusion gene types are important in-fluencing factors for CR in patients with newly diagnosed APL treated by ATRA in combination with ATO.