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目的探讨全返式维A酸(ATRA)、三氧化二砷(ATO)联合小剂量细胞毒药物(常规剂量的1/4~1/5)在早幼粒细胞白血病(acte promyelocytic lekemia,APL)诱导缓解过程风险控制的临床疗效观察。方法 22例APL患者(低、中危险组)随机分成治疗组和对照组。治疗组患者12例,对APL应用常规剂量ATRA、ATO联合小剂量细胞毒药物(常规剂量的1/4~1/5)。对照组患者10例,ATRA、ATO同治疗组,联合常规剂量细胞毒药物(按照2011版APL治疗指南)。结果两组患者的完全缓解率90%以上,差异无统计学意义(P>0.05);治疗组患者无脏器出血,感染发生率(4/12)33%,对照组患者脏器出血(3/10)30%。感染率(10/10)100%,其中肺炎发生率(2/10)20%,高白细胞发生率8.3%,差异有统计学意义(χ2=5.632,P<0.05);治疗组较对照组明显节约血液制品,血小板输注量减少81.6%,红细胞输注量减少50%,血浆输注量减少79.1%。疗效显著,差异有统计学意义(χ2=2.354,P<0.05)。结论小剂量细胞毒药物在APL诱导缓解中能有效的降低临床风险、节约血液制品输注。
Objective To investigate the effect of retrograde retinoic acid (ATRA) and arsenic trioxide (ATO) in combination with small doses of cytotoxic drugs (1 / 4-1 / 5) on the induction of remission by acte promyelocytic leukemia Clinical efficacy of risk control. Methods Twenty-two APL patients (low and middle risk group) were randomly divided into treatment group and control group. In the treatment group, 12 cases were treated with conventional ATRA and ATO combined with low dose of cytotoxic drugs (1/4 ~ 1/5 of the conventional dose). Control group of 10 patients, ATRA, ATO with the treatment group, combined with conventional doses of cytotoxic drugs (in accordance with the 2011 version of the APL treatment guidelines). Results The complete remission rate was 90% in both groups, with no significant difference (P> 0.05). In the treatment group, there was no organ bleeding and the incidence of infection was 4% (33%). In the control group, the organ bleeding / 10) 30%. The infection rate (10/10) was 100%. The incidence of pneumonia (2/10) was 20%, the incidence of high white blood cells was 8.3%, the difference was statistically significant (χ2 = 5.632, P <0.05) Blood products were saved, platelet transfusion decreased by 81.6%, erythrocyte transfusion decreased by 50% and plasma transfusion decreased by 79.1%. Significant effect, the difference was statistically significant (χ2 = 2.354, P <0.05). Conclusion Small doses of cytotoxic drugs can effectively reduce the clinical risk in APL induced remission and save the infusion of blood products.