| Purpose: To test the efficacy and adverse reactions of single-agent Realgar-Indigo Naturalis Formula(RIF)induced remission and sequential chemotherapy with relapsed acute promyelocytic leukemia(APL).Patients and Methods:In this retrospective study,23 patients with recurrent APL who were treated in the Hematology Department of The 967 Hospital of the Joint Service and Security Force of the Chinese People Liberationg Army were selected as the subjects.All patients met the diagnosis and treatment criteria of China's guidelines for the diagnosis and treatment of acute promyelocytic leukemia in 2018,and were all patients with relapsed myelogram,including 15 men and 8 women,with a median age of 40(17-63)years;23 of them were PML-RAR ? gene positive,and 2 were chromosomal t(15;17)positive.Among them,12 cases were treated with ATRA,1 case with ATO,6 cases with chemotherapy,3 cases with RIF before recurrence,and the data were available for analysis.Oral administration of RIF(0.25 g / tablet),0.75-1.25g/time after meals,three times a day;prednisone 40-60 mg / D may be used as the case may be,if the gastrointestinal symptoms are obvious,gradually reduce the dose until the withdrawal,after the patient has achieved complete remission(CR);small dose ha scheme may be used first: homoharringtonine(H)1mg / D,VD;Ara-C 10-20 mg / D,VD,If the patient is difficult to take the medicine orally,take 10 mg / D ATO injection for 1-2 weeks.If the patient can take food,change to RIF until the patient obtains CR.Patients with Cr received RIF and chemotherapy alternately.Two weeks of combined chemotherapy is a course of treatment,and four weeks of RIF is a course of treatment.At the beginning,each course of treatment was interrupted for 1 month.After 10 courses of treatment,each course of treatment was interrupted for 4 months,and then 5 courses of treatment were treated.After remission,the treatment lasted for 5 years.The dosage of RIF after remission was the same as that of induced remission.The chemotherapy regimen was as follows: Patients with Cr received RIF and combined chemotherapy alternately.Two weeks of combined chemotherapy is a course of treatment,and four weeks of RIF is a course of treatment.At the beginning,each course of treatment was interrupted for 1 month.After 10 courses of treatment,each course of treatment was interrupted for 4 months,and then 5 courses of treatment were treated.After remission,the treatment lasted for 5 years.The dosage of RIF after remission was the same as that of induced remission.The chemotherapy plan is as follows:1.HAC: H 2mg / D,VD,d1-d2;Ara-C 100 mg / D,VD,D1-D3;cyclophosphamide(CTX)800-1200 mg / D,VD,D3.2.HAD: H 2mg / D,VD,d1-d2;Ara-C 100 mg / D,VD,D1-D3;daunorubicin(DNR)40mg / D,VD,D3).3.HAE: H 2mg / D,VD,d1-d2;Ara-C 100 mg / D,VD,D1-D3;etoposide(VP-16)100mg / D,VD,D1-D3.4.HAM: H 2mg / D,VD,d1-d2;Ara-C 100 mg / D,VD,D1-D3;mitoxantrone(MIT)6mg / D,VD,D3.Result:1.Among the 23 patients,22 received complete remission of myelogram(BM CR).The rate of BM CR was 95.65%.The median time of obtaining BM CR was 47.5(21-70)days.2.23 cases were positive for PML-RAR? gene,20 cases got complete molecular remission(MCR),the MCR rate was 86.96%,and the median time of MCR was 6.2(3.2-8.6)months.3.During RIF treatment,one patient died on the 21 st day of treatment,and the cause of death was cerebral hemorrhage.4.23 patients were followed up until August 2019.2 patients(8.7%)relapsed after RIF induced remission.The median time of relapse was 25(23-27)months.CR was obtained after RIF induced remission again.5.The median follow-up time of the three patients was 19(1-169)months.The 5-year overall survival(OS)rate and disease-free survival(DFS)rate were 95.65% and 79.71%,respectively.Conclusion:Single drug RIF induced remission and sequential chemotherapy are effective in the treatment of relapsed APL patients,with high HCR rate and less side effects and tolerable It is the choice of treatment plan for patients with relapsed APL. |
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