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目的:探讨持续慢点三氧化二砷(As2O3)治疗儿童和成人急性早幼粒细胞白血病(APL)患者的疗效。方法:选取2007-2011年来我院就诊并采取持续慢点As2O3方式治疗的APL患者60例,其中儿童28例,成人32例。成人As2O3剂量为0.16 mg/kg,儿童为0.08 mg/kg,每分钟8滴,18-21 h完成,28天为一疗程。测量两组不同时间点的血总砷及血三价砷浓度,并记录治疗过程中高白细胞血症的发生率及高白细胞血症持续时间。结果:儿童中高白细胞血症的发生率为60.71%(17/28),明显高于成人的34.38%(11/32),差异有统计学意义(P<0.05)。成人高白细胞血症平均持续时间为7.4天(6-10天),明显高于儿童的5.53天(4-8天),差异有统计学意义(P<0.01)。成人不同时间点血总砷浓度高于儿童(P<0.01),同一时间点血三价砷浓度高于儿童;随着用药时间延长,成人和儿童血总砷浓度和三价砷浓度增加,差异有统计学意义(均P<0.01),于用药第14天达稳态。结论:儿童高白细胞血症发生率高于成人,持续时间短,血总砷及三价砷浓度水平低于成人。
Objective: To investigate the effect of continuous As2O3 treatment in children and adults with acute promyelocytic leukemia (APL). Methods: Sixty patients with APL who were admitted to our hospital from 2007 to 2011 and were treated with continuous As2O3 treatment were selected. Among them, 28 were children and 32 were adults. Adult As2O3 dose of 0.16 mg / kg, children 0.08 mg / kg, 8 drops per minute, 18-21 h to complete, 28 days for a course of treatment. Blood total arsenic and blood trivalent arsenic concentrations were measured at two different time points and the incidence of hypervolemic hyperlipidemia and duration of hypervolemicmia during the treatment were recorded. Results: The incidence of hyperleukocytosis in children was 60.71% (17/28), significantly higher than that in adults (34.38%, 11/32). The difference was statistically significant (P <0.05). The average duration of adult leukocytosis was 7.4 days (6-10 days), significantly higher than 5.53 days (4-8 days) in children, the difference was statistically significant (P <0.01). The concentrations of total arsenic in blood at different time points in adults were higher than those in children (P <0.01). The concentrations of trivalent arsenic in blood were higher than those in children at the same time point. With the prolongation of medication time, the concentrations of total and trivalent arsenic in blood in adults and children increased Statistically significant (all P <0.01), reached steady state on the 14th day after treatment. Conclusion: The incidence of hyperlipidemia in children is higher than that of adults, and the duration of blood is short. The levels of total arsenic and trivalent arsenic in blood are lower than those in adults.