| BackgroundAcute promyelocytic leukemia,as a kind of acute myeloid leukemia with unique cytogenetic features,most of the patients had characteristic chromosomal translocation,t(15;17)(q22;q21),PML/RAR ? fusion gene encodes PML/RAR ? fusion protein,blocking cell differentiation with the onset of dangerous and high fatality rate.In the 1980s-1990 s,with all-trans retinoic acid and arsenic trioxide application,the therapy of APL was greatly improved and APL becomes gradually a curative hematologic malignant tumor as a targeted therapy model.Although the treatment of APL has made considerable progress,the treatment is still lack of uniform standards,how to choose a more optimal treatment,reduce the rate of early death,especially to avoid recurrence of refractory and drug adverse,are worth us to think and solve.ObjectiveEvaluate the clinical efficacy and safety of the treatment program by reviewing the overall curative effects and adverse reactions of ATRA,ATO combined with chemotherapy in treatment of patients with APL,comparing remission induction results of different risk stratifications of patients,and with triple induction therapy analyzing the death cases to guide the next step of clinical practice.Method79 patients newly diagnosed with APL were selected from Hematological department of Tai'an Central Hospital from January 2010 to September 2017.According to the white blood cell(WBC)count and platelet(PLT)count,patients were divided into low / middle and high risk group.All patients were treated with ATRA,ATO combined with chemotherapy induction therapy and supportive treatments.During the period of treatment,the blood routine tests,liver and kidney functions,ECG,bone marrow cytology,PML/RAR ? fusion gene were inspected regularly.The patients were followed up for 25 months to monitor the patients illness and evaluate the curative effects.The overall complete remission(CR)rate,PML/RAR ? fusion gene negative rate,the time to reach CR,the time needed for acquiring PML/RAR ? fusion gene negative and the adverse reactions were observed.Statistical analysis of Overall survival(OS)rate,Disease-free survival(DFS)rate and Disease-free survival(PFS)rate were performed by SPSS19.0 software,and survival curves were drawn,and all deaths were discussed.Result1.The study included 79 cases of APL patients finally,71 cases(89.87%)received complete remission(CR)and PML/RAR ? fusion gene negative,while in addition to early death cases,the CR rate and PML/RAR ? fusion gene negative rate reached 100%.Except for 2 patients,all patients received CR after 1 courses of treatment.All the 71 patients(89.87%)got PML/RAR ? fusion gene negative after 1.51 ± 0.734 courses averagely.Between low/middle risk patients and high risk patients on CR rate and PML/RAR ? fusion gene negative rate there is no significant difference(p=0.093),but the low/middle risk patients can acquire PML/RAR ? fusion gene negative faster than the high risk patients(low/middle risk patients Vs high-risk patients= 1.40±0.664 courses Vs 1.79±0.855 courses).2.The median time of follow-up was 25 months(1 month to 72 months).2 cases(2.53%)occurred recurrence,and they are high risk patients.8 patients(10.13%)died,including 5 high-risk patients,2 middle risk patients,and 1 low risk patients.All death events happened in early state of the induction therapy,6 cases(3/4)died of cruor dysfunction,which included 3 cases(1/2)died of intracranial hemorrhage.No central nervous system leukemia(CNSL)occurred during the follow-up period.3.The overall survival rate of 79 patients with APL in this study was 89.87%.The difference was statistically significant between low/middle risk patients and high risk patients(94.5%Vs79.2%,p=0.041).When early deaths were removed,the total disease-free survival was 97.4%,and the difference was not statistically significant between low/middle risk patients and high risk patients(100% Vs 94.7%,p=0.104).Progression-free survival was the same as disease-free survival.4.Non hematologic adverse reactions occurred during: 12 cases of gastrointestinal reaction(15.20%),16 cases of abnormal liver function(20.25%),10 cases of headache(12.66%),7 cases of skin rash(8.86%),10 cases of edema(12.66%),5 cases of cardiac toxicity(6.33%),8 cases(10.13%)retinoic syndrome,and almost adverse reactions can be improved after symptomatic treatments and stopping treating temporarily to acquire successful complete remission.Conclusion1.The newly diagnosed APL patients can achieve higher CR rate and PML/RAR ? fusion gene negative rate with the therapy of ATRA,ATO combined with chemotherapy,which takes a short time.2.Gastrointestinal reaction and liver damage are the most common adverse reactions.The overall adverse reactions are mild and the patients are tolerable.3.Low/middle risk patients acquire remission faster than high risk patients.There are more recurrence events in high risk patients,but there was no difference through early risks in prognosis between the two groups.Cruor dysfunction is the main cause in early deaths. |
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