The Analysis Of Therapeutic Regimens On Induction Remission And Long-term Survival Of Adult Acute Promyelocytic Leukemia

ObjectiveTo analysis the effects on complete remission and long-term survival of different induction regimens and post-remission therapy in patients with adult acute promyelocytic leukemia.MethodsWe retrospectively analyzed newly diagnosed acute promyelocytic leukemia cases in our hospital, and compared the complete remission(CR) rate among groups of different induction regimens. We also compared the relapse rate, overall survival(OS) and disease free survival(DFS) among groups of different post-remission therapy. We usedχ2 test,t test and Mann Whitney test ,Kaplan-Meier survival curve and Log-Rank test for statistics analysis.ResultsThe induction regimen included with Arsenic Trioxide(ATO) had complete remission(CR) rate of 100%, compared with the regimens without ATO 71.4±9.04%(p=0.01). Patients with ATO regimen got complete remission faster (26.36±9.56days) than the regimens without ATO (47.26±22.21days, p=0.0001). After getting CR, post-remission therapy is an important prognostic factor of long-term survival. The group of post-remission treatment combining with ATRA, ATO and chemotherapy sequentially had a relapse rate of only 7.4% , lower than the group without ATO (ATRA/chemotherapy alternative) (40.0%, p=0.02). The 1-year, 3-years cumulated survival rate of the sequential therapy are 100%. The chemotherapy /ATRA alternative therapy had 1-year, 3-year survival rate of 87.84±8.01% ,59.13±13.14% (p=0.0032). 3-years DFS of sequential therapy group is 81.48±11.94%, while of ATRA/chemotherapy alternative group is only 51.32±13.72%(p=0.0078). We detected the PML/RARαfusion transcripts of 16 cases continuously. There were 5 patients whose PML/RARαturned to positive from negative, and 2 cases had hematological relapse, 3 cases are still in CR after strengthening therapy in time.ConclusionsThe regimen included ATO would increase CR rate, shorten the period to CR. The post-remission treatment combining with ATRA, ATO and chemotherapy sequentially had a low relapse rate, and would significantly improve the long-term survival of APL patients. Continuous detection of PML/RARαfusion transcripts is important for predicting hematological relapse and may direct the therapy.