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目的评价全反式维甲酸(ATRA)、三氧化二砷(As2O3)的联合化疗治疗方案对儿童急性早幼粒细胞性白血病(APL)的疗效。方法1995-07—2005-06在中山大学附属二院及广州市儿童医院共有14例患儿接受了含ATRA、As2O3的联合化疗方案,其中男10例,女4例;年龄2.1～12岁,平均6.7岁。所有病例起病时均有贫血、皮肤瘀斑或牙龈出血等表现;骨髓检查原始+幼稚细胞比例为59.0%～97.5%,其中M3a9例,M3b5例;8例患儿行PML-RARα融合基因检测,其中阳性6例。比较不同细胞学类型、化疗方案等对APL的疗效及对复发率的影响。结果14例中有12例(85.71%)使用上述的诱导缓解方案达到骨髓(BM)缓解CR1,由开始治疗到BMCR1的中位时间为5周(2～9周);该组病例使用As2O3、DA、HA、EA、DEA序贯或同时联合其它化疗的巩固方案,共2例复发,均为M3b;用不同的巩固方案对APL复发影响差异无显著性(P=0.195);含As2O3的方案进行维持治疗可能减少APL患儿的复发;是否加用VP/6MP+MTX序贯维持治疗对控制复发差异无显著性(P=0.66)。结论含ATRA、As2O3的联合化疗方案对儿童APL是一种有效的治疗方法,可以减少复发。
Objective To evaluate the efficacy of ATRA combined with As2O3 in children with acute promyelocytic leukemia (APL). Methods A total of 14 patients with ATRA and As2O3 received chemotherapy in the Second Affiliated Hospital of Sun Yat-sen University and Guangzhou Children’s Hospital from July 1995 to June 2005. There were 10 males and 4 females, aged 2.1-12 years, Average 6.7 years old. Anemia, skin ecchymosis or gingival bleeding were observed in all cases. The proportion of primitive + naive cells in bone marrow examination ranged from 59.0% to 97.5%, of which M3a was 9 cases and M3b was 5 cases. PML-RARα fusion gene was detected in 8 cases , Of which 6 were positive. To compare the different types of cytology, chemotherapy and other effects of APL and the impact on the recurrence rate. Results 12 (85.71%) of the 14 patients achieved the bone marrow (BM) remission CR1 by using the above induction remission program. The median time from the initiation of treatment to BMCR1 was 5 weeks (range 2-9 weeks). As2O3, DA, HA, EA, DEA combined with other chemotherapy, either in series or in combination, with a recurrence of 2 cases, all of which were M3b. There was no significant difference in APL recurrence with different consolidation protocols (P = 0.195) Maintenance treatment may reduce the recurrence of children with APL; whether to add VP / 6MP + MTX sequential maintenance treatment was no significant difference between control recurrence (P = 0.66). Conclusion The combined chemotherapy with ATRA and As2O3 is an effective treatment for children with APL and can reduce recurrence.