Arsenic trioxide in the treatment of newly diagnosed acute promyelocytic leukemia: A single center experience
Arsenic trioxide in the treatment of newly diagnosed acute promyelocytic leukemia: A single center experience
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DOI：
10.1002/ajh.10138
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发表时间：
2002-08-01
影响因子：
12.8
通讯作者：
Srivastava, A
中科院分区：
文献类型：
--
作者：
Mathews, V;Balasubramanian, P;Srivastava, A
三氧化二砷（As_2O_3）是治疗急性早幼粒细胞白血病（APML）的有效药物。大多数As 2 O3研究涉及标准治疗后复发的APML患者。1998年1月至2000年7月，14例患者被招募为一个正在进行的试验中的As 2 O3治疗新诊断的APML。以10 mg/天的剂量给予三氧化二砷，直至达到完全缓解（CR）。之后，巩固课程和维护计划组成的As 2 O3作为一种单一的代理商管理超过6个月。有3例与脑内出血相关的早期死亡：2例在第3天，1例在第4天。在11例可评价的患者中，1例在第21天死于继发于不受控制的脓毒症，而其余10例（91%）已达到CR。CR时间平均为52.3天（范围：34-70天）。1例患者出现孤立性中枢神经系统（CNS）复发，随后在接受三联鞘内化疗、颅骨放疗和额外4周全身As 2 O3治疗后进入第二次CR。该患者以及其余9例患者在中位随访15个月（范围：2-33个月）时继续保持CR。10例患者中有8例在巩固和维持治疗期间的不同时期实现了分子缓解。1例患者出现ATRA综合征，并给予柔红霉素（40 mg/天）2天。这种疗法的副作用很小，任何患者都不需要停止治疗。无明显肝毒性。根据我们的经验，三氧化二砷可有效诱导和维持APML患者的缓解，副作用极小。需要确定最佳方案和所需的总剂量。(C)2002 Wiley-Liss，Inc.
Arsenic trioxide (As2O3) has been found effective in the treatment in the treatment of acute promyelocytic leukemia (APML). Most studies with As2O3 involve patients with APML who have relapsed following standard therapy. Between January 1998 and July 2000, 14 patients were recruited for an ongoing trial of As2O3 in the treatment of newly diagnosed APML. Arsenic trioxide was administered at a dose of 10 mg/day until complete remission (CR) was achieved. Afterward, a consolidation course and a maintenance schedule consisting of As2O3 as a single agent were administered over 6 months. There were 3 early deaths related to intra-cerebral hemorrhage: two on day 3 and one on day 4. Of the 11 evaluable patients, one died on day 21 secondary to uncontrolled sepsis, while the remaining 10 (91%) have attained CR. The average time to CR was 52.3 days (range: 34-70 days). One patient developed an isolated central nervous system (CNS) relapse and subsequently went into a second CR following therapy with triple intrathecal chemotherapy, cranial irradiation, and an additional 4-week course of systemic As2O3. This patient, as well as the remaining nine, has continued to remain in CR at a median follow up of 15 months (range: 2-33 months). Eight out of 10 patients achieved molecular remission at variable periods during their consolidation and maintenance schedules. One patient developed an ATRA syndrome and was administered daunorubicin (40 mg/day) for 2 days. The side effects with this therapy were minimal and did not require cessation of therapy in any patient. There was no significant hepatic toxicity. In our experience, arsenic trioxide is effective in inducing and maintaining remission in patients with APML with minimal side effects. The optimal regimen and total dose required need to be defined. (C) 2002 Wiley-Liss, Inc.