The kinetics of white blood cell and the predictive factors of leukocytosis under oral or intravenous arsenic as the first-line treatment for acute promyelocytic leukemia
The kinetics of white blood cell and the predictive factors of leukocytosis under oral or intravenous arsenic as the first-line treatment for acute promyelocytic leukemia
复制标题
口服或静脉砷一线治疗急性早幼粒细胞白细胞动力学及白细胞升高的预测因素
DOI：
10.1016/j.leukres.2017.09.006
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发表时间：
2017-10-01
影响因子：
2.7
通讯作者：
Zhu, Hong-Hu
中科院分区：
文献类型：
--
作者：
Wang, Fang;Jia, Jin-Song;Zhu, Hong-Hu
目的：比较口服砷联合全反式维甲酸、三氧化二砷联合全反式维甲酸一线治疗非高危急性早幼粒细胞白血病(APL)患者外周血中白细胞的动态变化，探讨白细胞增多的预测因素。方法：对初诊的非高危急性早幼粒细胞白血病患者，采用口服雄黄-青黛(RIF)或ATO(n=29)不同诱导方案，对其白细胞绝对计数、倍增时间和峰值时间进行分析。以诱导过程中WBC计数的动态变化为终点。结果：在纳入的患者中，初诊和高峰白细胞计数的中位数分别为1.78×10(9)/L(0.31~9.89)和12.16×10(9)/L(1.56~80.01)。辨证分型发生率为9.38%。白细胞动态变化均呈单峰型，达峰时间中位数为10天(2~26天)。治疗10d后，肾间质纤维化组白细胞计数明显高于假手术组(9.22x10(9)/L vs.4.10x10(9)/L，p=0.015)。WBC峰值<10×10(9)/L的患者与WBC峰值较低的患者相比，WBC倍增时间较短(RIF组4天比7天，p=0.001；ATO组4.5d比23天，p=0.002)。单因素和多因素分析显示，WBC倍增时间是影响WBC数峰值的独立因素。结论：口服砷+ATRA和ATO+ATRA诱导WBC增殖的动力学不同。WBC倍增时间是预测WBC峰值的重要独立因素。
Objective: We aimed to compare the kinetics of white blood cell (WBC) and explore predictive factors of leukocytosis in non-high-risk acute promyelocytic leukemia (APL), with oral arsenic plus all-trans retinoic acid (ATRA) or intravenous arsenic trioxide (ATO) plus ATRA as a first-line treatment.Methods: The absolute count, doubling time and peak time of WBC were analyzed in 64 newly diagnosed non-high-risk APL patients who were treated with different induction regimens containing either oral Realgar-indigo naturalis formula (RIF) (n = 35) or ATO (n = 29). The end points were the dynamic changes of the WBC counts during induction. The time points started at day 1 and were selected over 3-day intervals for 28 days.Results: Among the 64 included patients, the median initial and peak WBC counts were 1.78 x10(9)/L (range 0.31-9.89) and 12.16 x 10(9)/L (range 1.56-80.01), respectively. The incidence of differentiation syndrome was 9.38%. The dynamic changes in leukocytosis showed a single peak wave in all the patients, and the median time to peak was 10 (range 2-26) days. A higher WBC count was observed in the RIF group than in the ATO group after 10 days of treatment (9.22 x 10(9)/L vs. 4.10 x10(9)/L, p= 0.015). Patients with the peak WBC count >10 x10(9)/L had a shorter WBC doubling time compared to patients with a lower peak WBC (RIF group 4 days vs. 7 days, p= 0.001; ATO group 4.5 days vs. 23 days, p= 0.002). Univariate and multivariable analyses showed that the doubling time of WBC is an independent factor for the peak WBC count.Conclusion: Different kinetics of WBC proliferation were observed during induction with oral arsenic plus ATRA and ATO plus ATRA. The doubling time of WBC is an important independent factor for predicting the peak WBC count.