Re: 第一例文献报道,是中国上海医院报道的。
TIStudies on treatment of acute promyelocytic leukemia with arsenic trioxide
diagnosed and 47 relapsed acute promyelocytic leukemia patients.AUNiu C, Yan
H, Yu T, Sun HP, Liu JX, Li XS, Wu W, Zhang FQ, Chen Y, Zhou L, Li JM, Zeng
XY, Yang RR, Yuan MM, Ren MY, Gu FY, Cao Q, Gu BW, Su XY, Chen GQ, Xiong SM
, Zhang TD, Waxman S, Wang ZY, Chen Z, Hu J, Shen ZX, Chen SJSOBlood. 1999;
94(10):3315. Fifty-eight acute promyelocytic leukemia (APL) patients (11
newly diagnosed and 47 relapsed) were studied for arsenic trioxide (As2O3)
treatment. Clinical complete remission (CR) was obtained in 8 of 11 (72.7%)
newly diagnosed cases. However, As2O3 treatment resulted in hepatic toxicity
in 7 cases including 2 deaths, in contrast to the mild liver dysfunction in
one third of the relapsed patients. Forty of forty-seven (85.1%) relapsed
patients achieved CR. Two of three nonresponders showed clonal evolution at
relapse, with disappearance of t(15;17) and PML-RARalpha fusion gene in 1
and shift to a dominant AML-1-ETO population in another, suggesting a
correlation between PML-RARalpha expression and therapeutic response. In a
follow-up of 33 relapsed cases over 7 to 48 months, the estimated disease-
free survival (DFS) rates for 1 and 2 years were 63.6% and 41.6%,
respectively, and the actual median DFS was 17 months. Patients with white
blood cell (WBC) count below 10 x 10(9)/L at relapse had better survival
than those with WBC count over 10 x 10(9)/L (P =.038). The duration of As2O3
-induced CR was related to postremission therapy, because there was only 2
of 11 relapses in patients treated with As2O3 combined with chemotherapy,
compared with 12 of 18 relapses with As2O3 alone (P =.01). Reverse
transcription polymerase chain reaction (RT-PCR) analysis in both newly
diagnosed and relapsed groups showed long-term use of As2O3 could lead to a
molecular remission in some patients. We thus recommend that ATRA be used as
first choice for remission induction in newly diagnosed APL cases, whereas
As2O3 can be either used as a rescue for relapsed cases or included into
multidrug consolidation/maintenance clinical trials. ADShanghai Institute of
Hematology, Department of Hematology