[Seven years' summary report on the treatment of acute promyelocytic leukemia with arsenic trioxide--an analysis of 242 cases]

Abstract

Objective: To observe the effectiveness of arsenic trioxide (As(2)O(3)) in the treatment of acute promyelocytic leukemia (APL).

Methods: Data of clinical observation, seven year follow-up survey were analysed with American SAS system software, concentration of arsenic in cerebrospinal fluid (CSF) was determined by atomic absorbing spectrum.

Results: The complete remission (CR) and effectiveness rates were 87.9% and 94.4% for the previously untreated group; 60.0% and 65.0% for the relapsed in As(2)O(3) maintenance treatment group; 69.5% and 84.8% for the relapsed in other than As(2)O(3) maintenance treatment group; and 48.7% and 94.1% for the refractory group, respectively. In the previously untreated group, the relapse rate at 3 years after CR was 26.7%. The probability of survival in 136 follow-up survey patients was 92.0% and 76.7% at 5 years and 7 years, respectively. There were mild side effects. Central nervous system leukemia (CNSL) occurred in 138 out of 412 cases in 6 years, including some refractory leukemia, extramedullary residual leukemia and extramedullary relapse. Prophylactic intrathecal injection could reduce the incidence rate of CNSL. Determination of arsenic concentration indicated that it was difficult for arsenic to penetrate the blood-brain barrier.

Conclusion: The CR rate and long-term survival are high and the relapse rate is low in APL patients treated with As(2)O(3). There is no cross-resistance between ATRA and As(2)O(3) and other chemotherapeutic agents. As(2)O(3)-resistance occurs scarcely. It can also be used in maintenance treatment.