中药砷剂为主方案对急性早幼粒细胞白血病长期生存的影响

发布时间：2018-02-05 02:50

本文关键词： 三氧化二砷砷剂急性早幼粒细胞白血病长期生存　出处：《中国中医科学院》2017年硕士论文　论文类型：学位论文

【摘要】：目的:进一步了解APL的发病特点,分析含砷中药对APL完全缓解率及长期生存的影响,观察砷剂不同治疗阶段应用的疗效,分析以中药砷剂为主方案治疗APL的疗程与时间,为进一步优化APL治疗方案提供依据。方法:以我院1991年2月-2017年2月26年间收治的APL患者110例为研究对象。初治就诊患者诱导及巩固阶段以砷剂为主治疗;在外院经维甲酸或者联合化疗诱导缓解后就诊我院的患者以砷剂为主巩固治疗;复发/难治就诊的患者使用砷剂再诱导。分析和比较所有APL患者的临床特点和长期生存情况。应用SPSS22.0软件进行统计学分析,采用KapLan-Meier曲线分析比较不同治疗方案对无复发生存率(RFS)、无事件生存率(EFS)和总生存率(OS)的影响。结果:110例APL患者,原发者占92.7%,肿瘤并发者占1.8%,银屑病并发者占5.5%。初治APL患者诱导CR率100%。诱导阶段即使用砷剂(初治就诊APL患者)组10年RFS率为97.5%,明显高于巩固阶段开始使用砷剂(巩固就诊APL 患者)组 80.6%(P0.05)。两组 5 年和 10 年 EFS 率分别为(94.8%VS78.6%)、(91.5%VS78.6%)(P0.05);OS 率分别为(94.8%VS86.4%)、(91.5%VS83.6%)(P0.05);复发就诊APL患者诱导CR率87.5%,10年OS率34.1%。生存5年且持续在我院治疗的29例初治APL患者,巩固维持治疗2.5个月～103个月,12～24个月者6例,平均AS_2O_3用量5.7±1.84个疗程,化疗2.75±0.75个疗程;25～36个月者7例,平均AS_2O_3用量7.44±1.02个疗程,化疗3±0.55个疗程;37～48个月者8例,平均AS_2O_3用量12.04±2.17个疗程,化疗3±0.58个疗程;49～60个月者1例,使用AS_2O_310个疗程,化疗5个疗程;60个月者3例,平均AS_2O_3用量15.32±6.61个疗程,化疗4.5±3.5个疗程;4例治疗12个月。13.3%初治APL患者在诱导过程中出现明显肝损害(ALT或AST300u/L),严重神经毒性反应者1例;共发现2例APL患者治疗后并发第2肿瘤。结论:(1)在APL治疗中,早期使用中药砷剂能明显提高缓解率,降低复发率。(2)巩固期开始使用中药砷剂比诱导期即使用复发患者增加,提倡在诱导期即采取以砷剂为主的诱导方案。(3)复发患者虽然多数可取得再次缓解,但缓解期短,长期无病生存率约占1/3。(4)以砷剂为主治疗方案仍具有优化的空间,砷剂的近远期毒性仍需关注。
[Abstract]:Objective: to investigate the characteristics of APL, to analyze the effect of arsenic containing Chinese medicine on the complete remission rate and long-term survival of APL, and to observe the curative effect of arsenic in different stages of treatment. To analyze the course and time of treating APL with traditional Chinese medicine arsenic as the main regimen. To provide the basis for further optimization of APL treatment. Methods:. 110 cases of APL patients admitted from February 1991 to February 26th 2017 in our hospital were studied. The patients in our hospital treated by retinoic acid or chemotherapy-induced remission were mainly treated with arsenic. The recurrent / refractory patients were reinduced by arsenic. The clinical characteristics and long-term survival of all patients with APL were analyzed and compared. SPSS22.0 software was used for statistical analysis. The recurrence free survival rate (RFSs) of different treatment regimens was compared by KapLan-Meier curve analysis. Results among the 110 patients with APL, 92. 7% were primary and 1.8% were complicated with tumor. The CR rate of the patients with primary APL was 100. In the induction stage, the RFS rate of 10 years was 97.5% in the arsenic group (initial treatment for APL patients). The EFS rates of the two groups were significantly higher than that of the group starting to use arsenic (consolidation of APL patients) in the period of consolidation (P 0.05). The EFS rates of the two groups were 5 and 10 years (P < 0.05). 94.8 VS78.6). VS78.6 and P0.05; The OS rates were 91.5 VS83.6 and 91.5 VS86.4, respectively. The induction CR rate was 87.5% in recurrent APL patients, and the OS rate was 34.1% in 10 years. 29 newly treated APL patients survived 5 years and continued to be treated in our hospital. The average dosage of AS_2O_3 was 5.7 卤1.84 courses and 2.75 卤0.75 courses of chemotherapy. The average dosage of AS_2O_3 was 7.44 卤1.02 courses and 3 卤0.55 courses of chemotherapy. The average dosage of AS_2O_3 was 12.04 卤2.17 courses of treatment and 3 卤0.58 courses of chemotherapy. One case of 49 ~ 60 months was treated with AS_2O_310 for five courses of chemotherapy. The average dosage of AS_2O_3 was 15.32 卤6.61 course of treatment and 4.5 卤3.5 course of chemotherapy. After 12 months of treatment, 4 patients with newly treated APL had significant liver damage, alt or AST 300u / L, and 1 patient had severe neurotoxic reaction. A total of 2 patients with APL were found to be complicated with the second tumor after treatment. Conclusion the early use of arsenic in the treatment of APL can significantly improve the remission rate. Reduce the recurrence rate. 2) beginning to use as in the consolidation period is higher than that in the induction stage, even in the patients with recurrence. It is recommended that the induction regimen with arsenic as the main inducer should be adopted in the induction period. Although most of the relapse patients can obtain the second remission, the remission period is short. Long-term disease-free survival rate accounts for about 1 / 3. 4) arsenic as the main therapeutic regimen still has room for optimization, and the short-term and long-term toxicity of arsenic still needs to be paid attention to.
【学位授予单位】：中国中医科学院
【学位级别】：硕士
【学位授予年份】：2017
【分类号】：R733.71

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