Effective Treatment of Acute Promyelocytic Leukemia With All-Trans-Retinoic Acid, Arsenic Trioxide, and Gemtuzumab Ozogamicin
Effective Treatment of Acute Promyelocytic Leukemia With All-Trans-Retinoic Acid, Arsenic Trioxide, and Gemtuzumab Ozogamicin
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DOI：
10.1200/jco.2008.18.6130
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发表时间：
2009-02-01
影响因子：
45.3
通讯作者：
Kantarjian, Hagop
中科院分区：
文献类型：
--
作者：
Ravandi, Farhad;Estey, Eli;Kantarjian, Hagop
PurposeWe研究了新诊断的急性早幼粒细胞白血病（APL）患者的治疗结果与全反式维甲酸（ATRA）和三氧化二砷（ATO）与或不与吉妥珠单抗ozogamicin（GO），但没有传统的细胞毒chemotherapy.Patients和MethodsFrom 2002年2月至2008年3月，82例APL患者与ATRA加ATO的组合治疗。第一组65例患者接受ATRA和ATO（从ATRA第10天开始）。高危患者（WBC>= 10 x 109/L）在第一天接受GO。从2007年7月开始，第二组17例患者在第1天同时接受ATRA和ATO治疗。如果有高风险，并且在诱导期间WBC增加至30 x 109/L以上，则在第1天也接受GO。监测PML-RARA融合基因进行诱导后，整个巩固和follow-up.ResultsOverall，74例患者达到完全缓解（CR），一个达到CR没有完全血小板恢复后的诱导，反应率为92%。7例患者在入选研究后中位4天（范围：1 - 24天）死于疾病相关并发症。中位随访时间为99周（范围：2 - 282周）。在有反应的患者中，3例在39、52和53周时复发。3例患者在CR 14、21和71周后死亡，均死于第二次恶性肿瘤。结论ATRA联合ATO（加或不加GO）作为APL的初始治疗方案是安全有效的，可替代含化疗方案。
PurposeWe 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 MethodsFrom 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 x 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 x 109/L during induction. Monitoring for PML-RARA fusion gene was conducted after induction and throughout consolidation and follow-up.ResultsOverall, 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%.ConclusionThe combination of ATRA and ATO (with or without GO) as initial therapy for APL was effective and safe and can substitute chemotherapy-containing regimens.