The impact of oral arsenic and all-trans-retinoic acid on coagulopathy in acute promyelocytic leukemia
The impact of oral arsenic and all-trans-retinoic acid on coagulopathy in acute promyelocytic leukemia
复制标题
口服砷和全反式维A酸对急性早幼粒细胞白血病凝血障碍的影响
DOI：
10.1016/j.leukres.2017.11.009
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发表时间：
2018-02-01
影响因子：
2.7
通讯作者：
Huang, Xiao-Jun
中科院分区：
文献类型：
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作者：
Zhu, Hong-Hu;Guo, Zhi-Ping;Huang, Xiao-Jun
本研究的目的是评估口服砷（天然帝王黄-靛蓝配方，RIF）和全反式维甲酸（ATRA）对急性早幼粒细胞白血病（APL）凝血功能的影响，并与诱导时静脉注射三氧化二砷（ATO）和ATRA进行比较。所有患者以1.4 mg/m(2) /天的剂量添加米托蒽醌，持续5-7天。比较分析83例新诊断APL患者（45例）和ATO治疗组（38例）的d -二聚体水平、凝血酶原时间（PT）、纤维蛋白原（Fbg）水平和血小板计数。自RIF和ATRA诱导治疗后，Fbg、PT和血小板的中位水平分别在4天、10天和28天恢复到正常范围。最后输血小板和血浆的时间分别为第12天（范围0 ~ 24天）和第3天（范围0 ~ 27天）。42例弥散性血管内凝血（DIC）评分为4分的患者中，RIF组输血小板消耗少于ATO组（P = 0.037）。在17例DIC评分< 4的患者中，RIF组的Fbg水平较ATO组迅速恢复（P = 0.028） （P = 0.401）。RIF和ATO对APL患者凝血功能恢复的作用相似。RIF在加速亚临床DIC患者血小板减少症和低纤维蛋白原血症的恢复方面具有潜在的有益作用。
The aim of our study was to evaluate the impact of oral arsenic (the realgar-indigo naturalis formula, RIF) and all-trans retinoic acid (ATRA) on coagulopathy in acute promyelocytic leukemia (APL) compared with intravenous arsenic trioxide (ATO) and ATRA during induction. Mitoxantrone was added to all the patients at a dose of 1.4 mg/m(2) per day for 5-7 days. D-dimer levels, prothrombin time (PT), fibrinogen (Fbg) levels and the platelet count were comparably analyzed among 83 newly diagnosed APL patients treated with RIF (n = 45) or with ATO (n = 38). Since induction therapy with RIF and ATRA, the median levels of Fbg, PT and platelets were recovered to the normal range within 4 days, 10 days and 28 days, respectively. The last day of platelet and plasma transfusion was day 12 (range: 0-24 days) and day 3 (range: 0-27 days), respectively. Among the 42 patients with a disseminated intravascular coagulation (DIC) score = 4, the consumption of transfused platelets was less in the RIF group than that in the ATO group (P = 0.037). In the 17 patients with a DIC score< 4, prompt recovery of Fbg levels (P = 0.028) was observed in the RIF group compared with that in the ATO group (P = 0.401). RIF and ATO showed similar effects on the recovery of coagulopathy in APL patients. RIF had a potential beneficial effect in accelerating the recovery of thrombocytopenia and hypofibrinogenemia for subclinical DIC patients.