Use of all-trans retinoic acid plus arsenic trioxide as an alternative to chemotherapy in untreated acute promyelocytic leukemia
Use of all-trans retinoic acid plus arsenic trioxide as an alternative to chemotherapy in untreated acute promyelocytic leukemia
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DOI：
10.1182/blood-2005-10-4006
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发表时间：
2006-05-01
期刊：
影响因子：
20.3
通讯作者：
Kantarjian, H
中科院分区：
文献类型：
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作者：
Estey, E;Garcia-Manero, G;Kantarjian, H
我们研究了联合全反式维甲酸(ATRA)和三氧化二砷(ATO)是否可以替代ATRA加化疗治疗初治的急性早幼粒细胞白血病(APL)。25例低危患者(白细胞<10×10(9)/L[10000/亩L])接受全反式维甲酸(45 mg/m(2)，每日1次)和全反式维甲酸(0.15 mg/kg，从全反式维甲酸第10天开始)治疗，完全缓解(CR)患者接受ATO加全反式维甲酸(ATRA)治疗，不进行化疗，除非自CR日起3个月逆转录-聚合酶链式反应(RT-PCR)阳性或分子复发。19名高危患者接受相同的治疗，但接受了化疗，一般在诱导的第一天给予吉珠单抗(GO)9 mg/m(2)。CR率为39/44(低危组24/25，高危组15/19)。在3名高危患者中，疾病分别在9、9和15个月时复发。首次CR存活的36例患者从CR之日起的中位随访时间为16个月(低风险患者15个月，高风险患者20个月)，其中9名患者至少随访24个月。在最后一次随访中，36名患者中的每一位都是PCR阴性。因此，没有一名低风险患者接受过化疗，只有3名高危患者(3名复发患者)在诱导后接受了化疗。Atria联合ATO可作为低危未经治疗的APL(例如，老年患者)化疗的替代方案，当与GO联合使用时，可能会改善高危患者的预后。
We examined whether combining alltrans retinoic acid (ATRA) and arsenic trioxide (ATO) might be an alternative to ATRA plus chemotherapy in untreated acute promyelocytic leukemia (APL). Twenty-five low-risk patients (white blood cell [WBC] count less than 10 x 10(9)/L [10 000/mu L]) received ATRA (45 mg/m(2) daily) and ATO (0.15 mg/kg daily, beginning day 10 of ATRA), and in complete remission (CR) received ATO plus ATRA, without chemotherapy, unless they were reverse transcriptase-polymerase chain reaction (RT-PCR)-positive 3 months from CR date or had molecular relapse. Nineteen high-risk patients were treated identically, but received chemotherapy, generally 9 mg/m(2) gemtuzumab ozogamycin (GO) on day 1 of induction. The CR rate was 39 of 44 (24 of 25 in low-risk, 15 of 19 in high-risk). Disease recurred at 9, 9, and 15 months, respectively, in 3 high-risk patients. The median follow-up time from CR date in the 36 patients alive in first CR is 16 months (15 months in low-risk, 20 months in high-risk), with 9 patients followed for at least 24 months. Each of the 36 patients was PCR-negative at last follow-up. Thus, none of the low-risk patients has received chemotherapy, and only 3 high-risk patients (the 3 with relapsed disease) have received chemotherapy past induction. ATRIA plus ATO may serve as an alternative to chemotherapy in low-risk untreated APL (eg, in older patients) and, when combined with GO, may improve outcome in high-risk patients.