急性早幼粒细胞白血病分子学缓解后限制细胞毒药物维持治疗的探索

发布时间：2018-04-02 00:09

本文选题：急性早幼粒细胞白血病　切入点：细胞毒药物　出处：《河北医科大学》2017年硕士论文

【摘要】：目的:探索急性早幼粒细胞白血病(APL)分子学缓解后限制细胞毒药物的维持治疗。方法:将符合细胞形态学、免疫学、细胞遗传学、分子生物学(MICM)分型标准的80例初治APL患者,采用全反式维甲酸(ATRA)单药或ATRA联合蒽环类药物进行诱导分化治疗,达完全缓解(CR)后采用蒽环类药物或联合阿糖胞苷(Arac)的方案巩固治疗2~3次,达分子学缓解后非完全随机分为2组,A组接受三氧化二砷(AS2O3)和ATRA交替序贯维持治疗,B组接受AS2O3和ATRA和化疗交替序贯维持治疗。比较2组患者维持治疗期间的并发症情况及治疗花费、无进展生存(PFS)率及总体生存(OS)率。结果:1 A组与B组的感染并发症发生率分别为20%(8/40)和67.5%(27/40)(χ2=18.337,P=0.000),A组的感染并发症明显低于B组(P0.05),差异有统计学意义;2患者每次住院花费平均数分别为11132.00元和12510.45元(t=5.145,P=0.031);A组的治疗花费明显低于B组(P0.05),差异有统计学意义;3 A组和B组5年预计PFS率分别为(75.2±13)%和(67.6±12.2)%(χ2=0.352,P=0.5530.05),两组PFS差异无统计学意义(P0.05);4 5年预计OS率分别为(95.2±4.6)%和(70.0±18.2)%(χ2=0.2000,P=0.6550.05),两组OS差异无统计学意义(P0.05)。结论:APL患者在获得完全分子学缓解后采用限制细胞毒药物维持治疗可以减少并发症发生及治疗花费。
[Abstract]:Objective: to explore the maintenance treatment of cytotoxic drugs after molecular remission of acute promyelocytic leukemia (AHL). Methods: 80 newly diagnosed APL patients who met the criteria of cell morphology, immunology, cytogenetics and molecular biology were used. All trans retinoic acid (ATRA) single drug or ATRA combined with anthracycline were used to induce differentiation, and complete remission was achieved, then the regimen of anthracycline or cytarabine was used to consolidate treatment for 23 times. After molecular remission, patients in group A were randomly divided into two groups: group A received AS2O3) and group B received alternative sequential maintenance therapy of AS2O3, ATRA and chemotherapy. Symptoms and treatment costs, Results the incidence of infection complications in group A and group B were 20 / 8 / 40) and 67.5 / 27 / 40 respectively (蠂 ~ (2) ~ (18) 337p ~ (0.000)) were significantly lower than those in group B (P = 0.05). The difference was statistically significant (P < 0.05). The incidence of infection complications in group A was significantly lower than that in group B (P = 0.05), and the incidence of infection complications in group A was significantly lower than that in group A (P < 0.05), and the incidence of complications in group B was significantly lower than that in group A (P < 0.05). The mean value of PFS in group A was 11132.00 yuan and 12510.45 yuan respectively. The cost of treatment in group A was significantly lower than that in group B (P 0.05). The difference was statistically significant between group A and group B, the estimated 5-year PFS rates in group A and group B were 75.2 卤13.1% and 67.6 卤12.2g respectively (蠂 20.352P 0.5530.05). There was no significant difference in PFS between the two groups. In order to achieve 95.2 卤4.6% and 70.0 卤18.2%, there was no significant difference in OS between the two groups (蠂 2 / 0.2000). Conclusion the treatment of limiting cytotoxic drug maintenance in patients with 1% APL can reduce the incidence of complications and the cost of treatment after obtaining complete molecular remission.
【学位授予单位】：河北医科大学
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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