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全反式视黄酸、三氧化砷和吉妥珠单抗奥唑米星可有效治疗急性早幼粒细胞白血病

Effective Treatment of Acute Promyelocytic Leukemia With All-Trans-Retinoic Acid, Arsenic Trioxide, and Gemtuzumab Ozogamicin
Ravandi F, Estey E, Jones D   |    2009/8/14 20:26:54   | 
J Clin Oncol  |   2009   |          View at Publisher
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上一篇： 利用临床和遗传药理学数据估计华法林剂量
下一篇： 浆液性输卵管上皮内癌：在原发性腹膜浆液性癌诊断及浆液性癌预防中的潜在作用
Purpose:
We examined the outcome of patients with newly diagnosed acute promyelocytic leukemia (APL) treated with all-trans-retinoic acid (ATRA) and arsenic trioxide (ATO) with or without gemtuzumab ozogamicin (GO) but without traditional cytotoxic chemotherapy.

Patients and Methods:
From February 2002 to March 2008, 82 patients with APL were treated with a combination of ATRA plus ATO. The first cohort of 65 patients received ATRA and ATO (beginning on day 10 of ATRA). High-risk patients (WBCs ≥ 10×109/L) received GO on the first day. From July 2007, the second cohort of 17 patients received ATRA and ATO concomitantly on day 1. They also received GO on day 1, if high risk, and if their WBC increased to more than 30×109/L during induction. Monitoring for PML-RARA fusion gene was conducted after induction and throughout consolidation and follow-up.

Results:
Overall, 74 patients achieved complete remission (CR) and one achieved CR without full platelet recovery after the induction, for a response rate of 92%. Seven patients died at a median of 4 days (range, 1 to 24 days) after inclusion in the study from disease-related complications. The median follow-up is 99 weeks (range, 2 to 282 weeks). Among the responding patients, three experienced relapse at 39, 52, and 53 weeks. Three patients died after being in CR for 14, 21, and 71 weeks, all from a second malignancy. The estimated 3-year survival rate is 85%.

Conclusion:
The combination of ATRA and ATO (with or without GO) as initial therapy for APL was effective and safe and can substitute chemotherapy-containing regimens.
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