The Efficient Therapy Of Acute Promyelocytic Leukmia (apl) Treated By The Combination Of Three Drugs And Blood Coagulation Factors

ObjectiveResearch of acute promylocytic leukemia (APL) treated by the combination of 3 drugs and blood coagulation factors.MethodsBased on different induction regimen,61 newly diagnosed APL patients were divided into four groups. Group A (experimental group) including 20 cases:retinoic acid, arsenic trioxide combined anthracycline, the combination of 3 drugs; Group B (control group 1) including 13 cases:arsenic trioxide and anthracycline; Group C (control group 2) including 15 cases:retinoic acid and chemotherapy; Group D (control group 3) including 13 cases:combination chemotherapy. Observe the remission rate, death rate, cases of high white blood cell, incidences of retinoic acid syndrome (retinoic acid syndrome, RAS) and the toxicity of liver, heart, nerve and kidney in four groups. Comparing fibrinogens in death and survival, study the influence for hemorrhagic death. Relative expressions of PML-RARa fusion gene which were detected from bone marrow of 15 patients regularly before and after the combination of 3 drugs were measured by real-time quantitative RT-PCR (RQ-RT-PCR).Results1. Remission rate and death rate:Complete remission rates of A, B, C, D groups were 100%,69.2%,84.6%,11.1% separately. Group A was compared with the other three groups (p<0.05). Remission rate of group A was significantly higher than the other three groups. Death rates were 0%,0%, 13.3%,30.7%.There was nobody dead in group A and B. Mortality rate of group A was lower than group B(p<0.05). The cause of death was cerebral hemorrhage.2. Side effect:durations of high white blood cell in group A, B and C were 10.83±4.8d,15.27±6.49d,18.31±6.92d.Group A was the shortest(P<0.05). Incidences of RAS in group A, B and C were 20.00%,15.38%,20.00%.There was no difference in three groups (p>0.05). Liver injury of group A happened more than the other three groups (50%) (p<0.05), but it was reversible. Incidences of toxicity in heart, nervous and kidney had no significant difference between group A and B which included arsenic trioxide(P>0.05).3. Fibrinogen:The fibrinogen of dead patients (0.65±0.31g/L) was significantly lower than survival patients (p<0.05).There was significant difference between the two groups.4. PML-RARa fusion gene level was lower at remission than before. The level of L-type decreased nearly one log and three logs of S-type. It was average for two logs.Conclusion1. The combination of 3 drugs curing APL had high remission rate and lower mortality.2. The combination of 3 drugs group has shorter duration of high white blood cell, increased liver injury which was reversible, did not aggravate retinoic acid syndrome and the toxicity in heart, nervous and kidney.3. Replenishing coagulation factors without delay to maintain fibrinogen 1.0g/L and above, the risk of fatal bleeding was significantly reduced.4. The combination of 3 drugs can quickly lower the level of PML-RARa fusion gene, and it was more sensitive for S-type.