Clinical Characteristics And Curative Effect Analysis Of 51 Cases Of Acute Promyelocytic Leukemia

Background:Acute promyelocytic leukemia(APL)has specific karyotype changes.Typical chromosome changes are represented by chromosome 15 and 17 translocation.According to FAB classification,it belongs M3.Its clinical manifestations are more dangerous.Bleeding,disseminated intravascular coagulation become the main cause of early death inpatients.In recent years,the application of all-trans-retinoic acid(ATRA)and arsenic in clinical practice has significantly improved the remission rate and survival time of APL patients.The all-trans retinoic acid or arsenical combined with anth racycline based chemotherapy is currently the standard induction protocol for newly diagnosed APL patients.Homoharringtonine(HHT)is an anti-tumor alkaloid extracted from plants.The HHT not only have the effect of inducing apoptosis,but also have the effect of inducing cell differentiation.And the cytotoxicity and myelosuppression of HHT are lighter.Therefore,this study is to compare the efficacy and adverse reactions of arsenic trioxide,cytarabine combined with anthracyclines,and HHT in the induction of remission period.Objective:To analyze the clinical features of the initial treatment of acute promyelocytic leukemia in our department of hematology and to compare the therapeutic effects and adverse reactions of the two treatment options in the induction of remission period.Methods:A retrospective analysis was performed in 51 patients with APL who are treated at our center from 2010 to 2017.To analyze the clinical features of APL patients and compare the efficacy and adverse reactions of arsenic trioxide,cytarabine combined with HHT or anthracycline in the induction of remission period.Statistical analysis was performed by SPSS21.0 to compare the complete remission rate,time to complete remission,leukemia-free survival time,incidence of adverse reactions and complications in the two groups.Results:1.Clinical characteristics:Among 51 patients with APL,23(45.1%)patients are females and 28(54.9%)patients are males.The youngest is 12 years old and the oldest is 74 years.The median age is 41 years old.The most common clinical manifestation is bleeding at admission.Among them,32 patients(62.74%)have different degrees of bleeding at the time of admission.The risk stratification was based on the number of peripheral blood leukocytes and platelets before induction therapy.Among them,12patients(23.53%)29 patients(56.86%),and 10 patients(19.61%)have low-risk,moderate-risk,and high-risk.All patients(100%)expressed CD33 and CD13.The positive expression rates of MPO,CD117,CD64,HLA-DR,CD34 and CD56 respectivelyare 92.16%,90.20%,88.24%,7.84%,9.80% and 13.73%.2.There is no significant difference between the complete remission rate and the time of complete remission(P=1.00,P=0.93).There is no significant difference in leukemia-free survival time between the two groups(P=0.148).In 51 patients,4 patients died on the 3rd,6th,20 th,and 27 th days of treatment respectively.The median time of death was 13 days.The early death rate was 7.84%.3.There is no statistical difference in liver function abnormalities,infection,retinoid syndrome,and disseminated intravascular coagulation(P>0.05),and the incidence of adverse cardiac reactions is statistically different(P=0.019).),It can be considered that the incidence of adverse cardiac reactions in the combined homoharringtonine group is lower than that of the combined anthracycline group,and its safety is higher.Conclusion:1.The most common clinical manifestation of APL patients is bleeding,and DIC-induced vital organ bleeding is the main cause of early death in APL patients.Most patients with APL have specific karyotype changes,accompanied by the formation of PML-RAR? fusion gene.Patients have a high expression of CD33,CD13,MPO,CD117 and CD64.Few patients expressed HLA-DR,CD34 and CD56.2.There is no statistical difference in the complete remission rate,complete remission time,leukemic survival time,hepatic toxicity,infection and disseminated intravascular coagulation in the two groups.The incidence of cardiotoxicity in the HHT group was lower than that in the anthracycline group,which could be used as a new strategy for newly diagnosed APL.Since the number of samples in this study is small and if the number of samples is further expanded,the analysis of the characteristics of APL and the comparison of the two groups of treatment plans will be more accurate.