Treatment of Acute Promyelocytic Leukemia with Aida Based Regimen. Update of a Tunisian Single Center Study
Treatment of Acute Promyelocytic Leukemia with Aida Based Regimen. Update of a Tunisian Single Center Study
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DOI：
10.4084/mjhid.2011.033
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发表时间：
2011-01-01
影响因子：
3.2
通讯作者：
Meddeb, Balkis
中科院分区：
文献类型：
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作者：
Jeddi, Ramzi;Ghedira, Hela;Meddeb, Balkis
在突尼斯，ATRA 时代始于 1998 年，连续使用 ATRA 和蒽环类药物加阿糖胞苷 (APL93) 和不加阿糖胞苷 (LPA99) 两种治疗方案。自 2004 年起，根据 PETHEMA LPA 99 试验，51 名经 t(15;17) 或 PML/RARA 确诊为 APL 的患者接受了治疗。 43 名患者达到 CR（86%）。其余7名患者早期死亡（1名在治疗开始前死亡）：4名死于分化综合征（DS），3名死于中枢神经系统出血。多变量分析显示，女性（P=0.045）、基线白细胞> 10 G/L（P=0.041）和血清肌酐> 1.4mg/dl（P=0.021）是诱导期间死亡率的预测因素。治疗开始后中位发病时间为 15 天后（范围为 2-29 天），16 名患者 (32%) 观察到 DS。体重指数 >= 30 (P=0.01) 是 DS 的唯一独立预测因子。高血压峰值的出现显着预测 DS 的发生（P=0.011），并且与高 BMI 显着相关（P=0.003）。中位随访时间为 50 个月，5 年累积复发率、无事件生存率和总生存率分别为 4.7%、74% 和 78%。
In Tunisia, the ATRA era began in 1998 with the use, consecutively, of two regimens combining ATRA and an anthracycline with cytarabine (APL93), and without cytarabine (LPA99). From 2004, 51 patients with confirmed APL either by t(15;17) or PML/RARA were treated according to the PETHEMA LPA 99 trial. Forty three patients achieved CR (86%). The remaining seven patients had early death (one died before treatment onset): four caused by differentiation syndrome (DS) and three died from central nervous system hemorrhage. Multivariate analysis revealed that female gender (P=0.045), baseline WBC> 10 G/L (P=0.041) and serum creatinine > 1.4mg/dl (P=0.021) were predictive of mortality during induction. DS was observed in 16 patients (32%) after a median onset time of 15 days from treatment onset (range, 2-29). Body mass index >= 30 (P=0.01) was the only independent predictor of DS. Occurrence of hypertensive peaks significantly predicted occurrence of DS (P=0.011) and was significantly associated with high BMI (p=0.003). With a median follow-up of 50 months, 5 year cumulative incidence of relapse, event free and overall survival were 4.7%, 74% and 78%, respectively.