| In recent decades, the incidence of leukemia has been increasing gradually, and the number of leukemia patients are increasing year by year. It brings great harm to people's health. The treatment of leukemia has been great concern. The combination of Traditional Chinese Medicine (TCM) in-depth study with the development of modern medicine has opened up a new gateway for leukemia treatment.Application of all-trans retinoic acid (ATRA) has opened the door targeted to acute promyelocytic leukemia (APL) and good outcomes have been observed. Application of arsenic preparations has increased the clinical cure rate of APL. APL has been a first disease in clinical application of inducing differentiation and targeting to tumor-specific markers and a significant effect on malignant tumors has been obtained. It has been a hematologic malignancy which could be cured. This paper relatively analysis the clinical outcome of different treatment and differentiation of symptoms in APL patients based on literature review, and the objective evidence of better clinical treatment could be provided.Part one The comparative analysis on clinical outcome of different treatment in patients with acute promyelocytic leukemiaObjective:To analysis the clinical efficacy of different treatment on patients with APL, then the best combinated plan of treatment in APL could be found out, and the evidence of more effective therapy could be provided.Methods:The 74 cases of APL were the hospital patients from September 1993 to September 2007, and the clinical efficacy.of 72 out of 74 cases was evaluated Inductive treatments included:ATRA alone, arsenic trioxide (As2O3) alone, ATRA combined with chemotherapy, and As2O3 combined chemotherapy. All patients took cooling blood detoxification-based medicinal broth during in inductive therapy. The remission rate (CR), the time to get complete remission(TC), the rate of relapse, relapse-free survival (RFS) and overall survival (OS) were compared in the four groups.71 patients who had achieved CR were divided into two groups when 30 days was as a boundary. Their RFS and OS were compared. The post-remission treatments included arsenic alone and arsenic combined with chemotherapy, and the 5-year RFS and OS estimated between two groups were compared.Results:All of patients with APL in four inductive therapy groups reached CR, the CR rate in each group was 100%. The TC was 28.31±4.5 days in As2O3 alone group. It was significantly shorter than that in other groups(P<0.05). The recurrence rate in four groups at 2 years were 11.8%,0%,14.3% and 14.3%, respectively; the 5-year RFS and OS were 82.4% and 88.2%,81.3% and 81.3%,78.6% and 85.7%, 71.4% and 71.4%, respectively. The RFS in four groups was not significantly different, so was the OS. The RFS and OS were significantly shorter in group of TC more than 30 days than that in group of TC less than 30 days(P<0.05). The 5-year RFS and OS of patients with the post-remission treatment were estimated of 85.7% and 85.7%,90.0% and 90.0%, respectively. The RFS between two groups was not significantly different, so was the OS.Conclusions:(1) The CR rate was not significantly different in patients with APL treated with four programs. (2) The TC was shorter in patients used by As2O3 alone than that by other programs. (3)Combinative medication didn't decrease the 2-year relapse rate and didn't increase the 5-year survival rate. (4) Patients with APL might have a longer survival as the TC less than 30 days. (5) The 5-year RFS and OS were not significantly different in patients with a post-remission treatment of As2O3 alone or As2O3 and chemotherapy in turn. Part two The comparative study on clinical outcomes of differentiation of symptoms and signs in patients with acute promyelocytic leukemiaObjective:To analysis the CR rate, relapse rate, and survival rate in APL patients based on differentiation of symptoms and signs, and to investigate the prognosis of APL patients with different pattern of syndrome.Methods:The 85 cases of APL were the hospital patients from September 1993 to September 2007. The detailed symptoms were recorded in these cases at initial diagnosis. The differentiation of symptoms and signs for classification of syndrome was used by virtue of questionnaire form comprised of symptoms and signs. The CR rate and relapse rate were analyzed by Fisher exact test, and the survival was analyzed by product limit method with a follow-up from the time of diagnoses to January 2010, and 10 patients were lossed to follow up.Results:The types of syndrome in APL patients were classified as deficiency of QI, deficiency of both QI and blood, deficiency of QI and yin, excessive heat and deficiency of QI, and other. The CR rate was 100%,91.7%,88.9%, and 89.5%, respectively, the CR rate were not significantly diferent in four groups. The RFS of patients with QI deficiency, QI and blood deficiency, QI and yin deficiency and predominant heat deficiency of QI and other were 0.70±0.19 (x±1.96s),0.83±0.21,0.78±0.27,0.57±0.23,0.66±0.27, respectively, the RFS curve become flattened after 5 years, and the RFS were not significantly diferent in four groups. The OS of patients with QI deficiency was 0.91±0.12 (x±1.96s), and the OS curve became flattened after 3 years; The survival rate of patients with QI and blood deficiency was 0.92±0.16, and the OS curve became flattened after 1 year; The OS rate of patients with QI and yin deficiency was 0.78±0.27, and the OS curve becomes flattened after 2 years; The OS of patients with excessive heat and QI dificiency was 0.57±0.23, and the survival curve becomes flattened after 9 years; The OS of patients with other was 0.66±0.27, and the OS curve becomes flattened after 5 years;. The OS curves changed dramatically during 1 year after diagnosis, and the incidence of death was high. The OS rate of patients with excessive heat and QI dificiency was significantly lower than that of those with other types (P<0.05).Conclusions:(1) The CR rate and RFS of APL patients were similar in four groups, so was the relapse rate. (2) The APL patients with deficiency of QI had a long life and a good prognoses, while the patients with excessive heat and QI deficiency had a short survival and a poor prognoses. (3)It might be appropriate to keep the maintenane therapy time for 2-3 years in patients without excessive heat..Contrarily, it might be necessary to prolong the treatment time in patients with excessive heat to reduce the incedence of relapse and death. |
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