Meta Analysis On Different Therapy After Complete Remission In The Treatment Of Acute Promyelocytic Leukemia

Acute promyelocytic leukemia (APL) is a kind of dangerous prognosis of leukemia, is a special subtype of acute myeloid leukemia, accounting for about 6.2%-40.2% of acute myeloid leukemia. It is rapid onseting and seriously ill, often accompanied by severe bleeding and DIC. The coming out of targeted drugs all trans retinoic acid (ATRA) and arsenic trioxide (As₂O₃) increase the complete remission rate and reduce early mortality. The patients with APL after complete remission were not given consolidation therapy will recur in the near future in majority,so consolidation therapy after complete remission is essential. At present, many researches have been conducted, home and abroad, but the unified view has not been reached.Objective: To compare different maintenance treatments of the acute promyelocytic leukemia, better one was chosen to decrease recurrence rate, prolong disease-free survival and overall survival, improve quality of life of acute promyelocytic leukemia patients.Methods: From 1980 to 2010, We searched PUBMED, EMBASE, MEDLINE, CNKI, CMCC and VIP using Cochrane Collaboration systematic review methods to obtain randomized controlled trials about different maintenance treatments of acute promyelocytic leukemia.Handsearch was conducted. Recurrence rate,disease-free survival (DFS) and overall survival (OS) are evaluation indexs.Meta-analysis from Revman 4.2.2 software of Cochrane Collaboration was adopted.The best way to treat acute promyelocytic leukemia was determined by comparing the recurrence rate, disease-free survival, disease-free survival rate and all survival rate of APL patients treated with different post-remission treatment.Results: 24 randomized controlled trials comprising 2892 cases of APL patients were identified and absorbed, quality assessment were moderate risk of bias.Meta analysis showed that compared with single ATRA group, chemotherapy + ATRA +6 MP + MTX group can reduce recurrence rate, increase 3 or 5-year overall survival, prolong disease-free survival. The maintenance treatment of ATRA group is superior to the observation group in recurrence rate, disease-free survival, overall survival. The recurrence rate of ATRA + 6MP + MTX for maintenance treatment is lower than the observation group. The recurrence rate of ATRA + 6MP + MTX program for maintenance treatment is lower than ATRA maintenance treatment,but 5 years disease-free survival and 3 years overall survival are higher.The recurrence rate of chemotherapy + ATRA + As₂O₃ is lower than chemotherapy+ATRA, but 3 years disease-free survival is higher . ATRA+As₂O₃+6MP+MTX program for maintenance treatment is inferior to ATRA+6MP+MTX program in recurrence rate.Conclusion: 1 Maintenance treatment can reduce the recurrence rate, increase disease-free survival and overall survival. 2 Maintenance treatment combined with low dose chemotherapy can enhance the curative effect and improve survival quality. 3 The maintenance treatment combined with As₂O₃ can improve the curative effect, reduce recurrence, and improve the long-term survival. 4 For high-risk patients high-dose cytarabine for consolidate treatment can further reduce the recurrence rate. 5 Anthracycline-based chemotherapy for consolidate treatment, ATRA +As₂O₃+ low dose chemotherapy for maintenance treatment is the best strategy after complete remission in the treatment of acute promyelocytic leukemia.