Treatment of acute promyelocytic leukemia with single-agent arsenic trioxide.
Treatment of acute promyelocytic leukemia with single-agent arsenic trioxide.
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DOI：
10.4084/mjhid.2011.056
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发表时间：
2011
影响因子：
3.2
通讯作者：
Srivastava A
中科院分区：
文献类型：
--
作者：
Mathews V;Chendamarai E;George B;Viswabandya A;Srivastava A
众所周知，三氧化二砷（ATO）是治疗急性早幼粒细胞白血病（APL）的有效药物。使用单药 ATO 治疗 APL 可使大多数患者得到持久缓解。 ATO 可能是治疗 APL 最有效的单一药物，并且很少有关于原发性耐药的报道。它既可以作为单一药物使用，也可以与其他常规药物联合使用来治疗 APL。 ATO 的使用是复发性 APL 治疗中公认的护理标准，它通常被有效地用作干细胞移植的桥梁。然而，其在新诊断的 APL 中的作用仍存在争议。 ATO 可能有多种作用机制。更好地了解其作用机制可能会导致更合理地单独使用该药物或其衍生物或与其他药物联合使用。单药ATO治疗APL后白血病清除和正常造血恢复的动力学数据有限，初步数据表明它可能与常规治疗不同。人们对该药物潜在的短期和长期毒性存在许多担忧。大多数此类担忧源于长期暴露于环境中砷的人的毒性特征。就恶性肿瘤治疗中 ATO 的治疗剂量和给药方案而言，总体毒性特征是有利的。在资源有限的环境中，使用基于 ATO 的单一药物治疗方案是治疗几乎所有患者的现实且可接受的选择。在发达国家，它有可能与其他药物联合使用，通过降低化疗剂量强度来改善临床结果，并且仍然是无法耐受常规治疗的患者的一种选择。在这篇综述中，我们重点讨论单药ATO治疗APL的情况，并总结我们的经验并回顾文献。
It is well recognized that arsenic trioxide (ATO) is an efficacious agent for the treatment of acute promyelocytic leukemia (APL). Use of single agent ATO in the treatment of APL leads to remissions which are durable in the majority. ATO is probably the most effective single agent in the treatment of APL and there have been very few reports of primary resistance. It has been used both as a single agent and in combination with other conventional drugs to treat APL. Use of ATO is the accepted standard of care in the management of relapsed APL, where it is often used effectively as a bridge to a stem cell transplant. However, its role in newly diagnosed APL remains controversial. ATO probably has multiple mechanisms of action. Better understanding of its mechanisms of action/s is likely to lead to more rationale use of this agent or its derivatives either alone or in combination with other drugs. There is limited data on the kinetics of leukemia clearance and normal haematopoietic recovery after the administration of single agent ATO for the treatment of APL, preliminary data suggests that it is likely to be different from conventional therapy. There have been a number of concerns of the potential short and long term toxicity of this agent. Most such concerns arise from the toxicity profile noted in people exposed to long term arsenic exposure in the environment. With the therapeutic doses and schedules of administration of ATO in the treatment of malignancies the overall toxicity profile has been favorable. In a resource constrained environments the use of a single agent ATO based regimen is a realistic and acceptable option to treat almost all patients. In the developed world it has the potential in combination with other agents to improve the clinical outcome with reduction of dose intensity of chemotherapy and remains an option for patients who would not tolerate conventional therapy. In this review we focus on the use of single agent ATO for the treatment of APL and summarize our experience and review the literature.