【摘要】 目的探讨全反式维甲酸(ATRA)与砷剂联合化疗对儿童初诊急性早幼粒细胞白血病(APL)的疗效和不良反应。方法1994年10月至2006年5月在西安市儿童医院共收治儿童APL6例,男2例,女4例。诱导缓解期:例1用ATRA联合化疗,例2用DAE[(D:柔红霉素(DNR);A:阿糖胞苷(Ara-C);E:足叶乙甙(Vp16)]方案无效,换用ATRA和三氧化二砷(As2O3)治疗。例3~6用ATRA、As2O3联合化疗。巩固治疗:例1用DA方案,例2用As2O3,例3~6用DAE方案。维持治疗:例1、2用青黄散、化疗、6-巯基嘌呤(6-MP)和甲氨蝶呤(MTX)各1个月交替用药。例3~6用大剂量阿糖胞苷(HD-Ara-C)4~6个疗程,其间间隙用DA、HA(H:高三尖杉酯碱)方案,共8~10个疗程以后,再交替用As2O3、6-MP+MTX、ATRA各1个月,总疗程3年。结果例1诱导缓解期第45天获完全缓解(CR),余5例均在第30天达CR,期间无严重出血及骨髓抑制,不良反应有恶心、腹痛、皮疹、心电图异常。随访11~152个月,均为持续完全缓解,例2~6获分子生物学缓解,3例分别停药116、16、14个月。血砷测定均未达到中毒浓度。结论砷剂联合ATRA、化疗适合初诊儿童APL的治疗,总体预后良好。更多还原

【Abstract】 Objective To investigate the therapeutic efficacy and the side-effects of chemotherapy with all-trians retinoic acid(ATRA),chemotherapy with arsenic trioxide and chemotherapy for children with original acute promylocytic leukemia(APL).Methods In remission induction,case 1 was treated with ATRA chemotherapy,case 2 was treated with ATRA and As2O3,cases 3 ~ 6 were treated with combination of ATRA and As2O3 chemotherapy.In postremission therapy,case 1 was treated with DA,case 2 was treated with As2O3,and cases 3 ~ 6 were treated with DAE.In maintenance therapy,case 1 and 2 were treated with Qing Huang San,chemotherapy,6-MP and MTX monthly in turn.Cases 3 ~ 6 were treated for 4 ~ 6 periods with HD-Ara-c.In intermission of HD-Ara-c,the patients were treated for 8~10 periods with DA and HA,and then one month with As2O3,6-MP and MTX,ATRA respectively.All period of treatment was 3 years.Results Case 1 obtained complete remission at 45 days after remission therapy.Others obtained complete remission at 30 days.There were no severe bleeding and inhibition of bone marrow.Side-effects of treatment were nausea,bellyache,tetter and abnormal ECG.The patients remained in CR at 14~116 months.Chromosomal abnormalities returned to normal in case 2~6.Conclusion The combination of ATRA and arsenic trioxide chemotherapy is safe and effective in children with original APL.更多还原