The Effect Of Arsenic Trioxide In APL Different Treatment Stages And Survival Analysis

Objective:Analysis the effect of arsenic trioxide in APL different treatment stages and survival analysis.Methods:154cases of acute promyelocytic leukemia frome the hematology department of xiangya2nd hospital blood internal medicine Between January2007and June2013were retrospective analysised. The treatment regimens are as follows:Between January2007and January2010,68cases received AS2O3in combination with ATRA for remission induction, is the Group A, patients who achevied CR received consolidation therapy sequence according to three courses XA, one course AS2O3, and then two course XA(X means DNR, HHar or THP), and then was two-year maintenance treatment, using ATRA and intermittent chemotherapy. Between February2010and June2013,86cases received ATRA and chemotherapy for remission induction, is the Group B, in Group B, the patients who achevied CR received consolidation therapy sequence according to one course XA, one course AS2O3, two courses XA, one course AS2O3and then one course XA (X means DNR, HHar or THP), the maintenance treatment was the same as A group. Compare the complete response rate, early mortality rate, the time to CR, overall survival (OS) and relapse-free survival (RFS) of two different regimens including AS2O3, and through the chi square test and Logistic regression model for analying the factors may have influence on complete response rate and early mortality rate, and through the Log Rank test and COX regression model for statistical analysis of the factors may affect overall survival (OS) and relapse-free survival (RFS).Results:The complete response rates of Group A and group B were83.8%and89.5%respectively, early mortality rate is14.7%and8.1%, P>0.05, the time to CR were28.33±0.952d and31.89±1.166d respectively, P=0.028, The mean follow-up time of GroupA/B were28.9months and26.2months respectively, the overall survival rate and RFS relapse-free survival rate were87.5%and84.4%,95.9%and84.4% respectively, P values were0.228and0.531, there were no statistically significant differences. As to A group, Single factor analysis think that the cases with leukemia cell count≥10×109/L, high-risk groups and existing severe blood coagulation dysfunction had a low complete response rate and a high early mortality rate. Logstic regression analysis confirmed that the white blood cell count and blood coagulation dysfunction were the independent risk factors affecting the early mortality rate, and blood coagulation dysfunction degree was also the independent risk factor of complete response rates; In group B, the single factor analysis think that degree of coagulation dysfunction was the important factor influencing the early mortality rate, and degree of coagulation dysfunction, leukemia cell count and risk-group were important factors influencing complete response rate, but they are not proved to be independent risk factors. Single factor analysis think that sex was the important factor affecting the relapse-free survival and overall survival in group A, the time to CR length is an important factor affecting overall survival time of group B, and COX regression confirmed that the time of CR and white blood cell count are the independent risk factors influencing the group B relapse-free survival.Conclusion:1. There was no significant statistical difference in curative effect of the intervention of Arsenic trioxide in the different stages of APL treatment, but the overall survival rate of cases with ATRA and chemotherapy for remission induction, and the consolidation treatment including two courses AS2O3had a obvious rise, more time and more large-scale clinical trial is needed to confirm.2. In the group of AS2O3in combination with ATRA for remission induction and the consolidation treatment including one course AS2O3, the cases with the White blood cell count≥10×109/L and severe blood coagulation function have a high early mortality rate, and the cases with severe blood coagulation dysfunction also have a low complete remission rate, the men have a low overall survival rate and relapse-free survival rate than women, the difference is statistically significant.3. In the group of ATRA and chemotherapy for remission induction, and the consolidation treatment including two courses AS2O3, the cases with severe coagulation dysfunction, leukemia cell count×10×109/L and high-risk group have a low complete remission rate, the cases with severe coagulation dysfunction a high early mortality rate. The cases of time to CR≥60day and leukocyte count≥10×109/L have a low relapse-free survival rate, and the cases with the time to CR>60day also have a low overall survival rate, the difference is statistically significant.