Relation of Blood Arsenic Concentration with Effect and Safety of Arsenic-Containing Qinghuang Powder (青黄散) in Patients with Myelodysplastic Syndrome
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摘要
Objective: To investigate the relation of blood arsenic concentration(BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder(青黄散, QHP) in patients with myelodysplastic syndrome(MDS). Methods: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluorescence spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. Results: After 2 courses of treatment, the total effective rate was 89.6%(146/163), with 31.3%(51/163) of hematological improvement and 58.3%(95/163) of stable disease. The hemoglobin increased from 73.48±19.30 g/L to 80.39±26.56 g/L(P<0.05), the absolute neutrophil count increased from 0.81±0.48×10~9/L to 1.08±0.62×10~9/L(P<0.05), and no significant changes were observed in platelet counts(P>0.05). Among 46 patients previously depended on blood transfusion, 28.3%(13/46) completely got rid of blood transfusion and 21.7%(10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17±18.04 μg/L(P<0.05), 3 months with 33.56±15.28 μg/L(P<0.05), and 6 months with 36.78±11.92 μg/L(P<0.05), respectively, as compared with those before treatment(4.08±2.11 μg/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months(P>0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases(8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions(22.39±10.38 vs. 37.89±11.84, μg/L, P<0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment(40.41±11.69 vs. 23.84±12.03, μg/L, P<0.05). Conclusion: QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.
Objective: To investigate the relation of blood arsenic concentration(BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder(青黄散, QHP) in patients with myelodysplastic syndrome(MDS). Methods: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluorescence spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. Results: After 2 courses of treatment, the total effective rate was 89.6%(146/163), with 31.3%(51/163) of hematological improvement and 58.3%(95/163) of stable disease. The hemoglobin increased from 73.48±19.30 g/L to 80.39±26.56 g/L(P<0.05), the absolute neutrophil count increased from 0.81±0.48×10~9/L to 1.08±0.62×10~9/L(P<0.05), and no significant changes were observed in platelet counts(P>0.05). Among 46 patients previously depended on blood transfusion, 28.3%(13/46) completely got rid of blood transfusion and 21.7%(10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17±18.04 μg/L(P<0.05), 3 months with 33.56±15.28 μg/L(P<0.05), and 6 months with 36.78±11.92 μg/L(P<0.05), respectively, as compared with those before treatment(4.08±2.11 μg/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months(P>0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases(8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions(22.39±10.38 vs. 37.89±11.84, μg/L, P<0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment(40.41±11.69 vs. 23.84±12.03, μg/L, P<0.05). Conclusion: QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.
Objective: To investigate the relation of blood arsenic concentration(BAC) with clinical effect and safety of arsenic-containing Qinghuang Powder(青黄散, QHP) in patients with myelodysplastic syndrome(MDS). Methods: Totally 163 patients with MDS were orally treated with QHP for 2 courses of treatment, 3 months as 1 course. The BACs of patients were detected by atomic fluorescence spectrophotometry at 1, 3, and 6 months during the treatment, and the effective rate, hematological improvement and safety in patients after treatment with QHP were analyzed. Results: After 2 courses of treatment, the total effective rate was 89.6%(146/163), with 31.3%(51/163) of hematological improvement and 58.3%(95/163) of stable disease. The hemoglobin increased from 73.48±19.30 g/L to 80.39±26.56 g/L(P<0.05), the absolute neutrophil count increased from 0.81±0.48×10~9/L to 1.08±0.62×10~9/L(P<0.05), and no significant changes were observed in platelet counts(P>0.05). Among 46 patients previously depended on blood transfusion, 28.3%(13/46) completely got rid of blood transfusion and 21.7%(10/46) reduced the volume of blood transfusion by more than 50% after treatment. The BACs were significantly increased in patients treated for 1 month with 32.17±18.04 μg/L(P<0.05), 3 months with 33.56±15.28 μg/L(P<0.05), and 6 months with 36.78±11.92 μg/L(P<0.05), respectively, as compared with those before treatment(4.08±2.11 μg/L). There were no significant differences of BACs among the patients treated for 1, 3 and 6 months(P>0.05). The adverse reactions of digestive tract during the treatment were mild abdominal pain and diarrhea in 14 cases(8.6%), and no patients discontinued the treatment. The BACs of patients with gastrointestinal adverse reactions were significantly lower than those without gastrointestinal adverse reactions(22.39±10.38 vs. 37.89±11.84, μg/L, P<0.05). The BACs of patients with clinical effect were significantly higher than those failed to treatment(40.41±11.69 vs. 23.84±12.03, μg/L, P<0.05). Conclusion: QHP was effective and safe in the treatment of patients with MDS and the effect was associated with BACs of patients.
引文
1.Garcia-Manero G.Myelodysplastic syndromes:2015Update on diagnosis,risk-stratification and management.Am JHematol 2015;90:831-841.
2.Hu XM,Liu F,Ma R.Application and assessment of Chinese arsenic drugs in treating malignant hematopathy in China.Chin J Integr Med 2010;16:368-377.
3.Xu S,Ma R,Hu XM,Xu YG,Yang XH,Wang HZ,et al.Clinical observation of the treatment of myelodysplastic syndrome mainly with Qinghuang Powder.Chin J Integr Med2011;17:834-839.
4.Sun SZ,Ma R,Hu XM,Yang XH,Xu YG,Wang HZ,et al.Karyotype and DNA-methylation responses in myelodysplastic syndromes following treatment with traditional Chinese formula containing arsenic.Evid Based Complement Alternat Med2012;969476.doi:10.1155/2012/969476.
5.Ma JL,Qu WW,Hu XM.Correlationship of clonal selection of treatment with arsenious compound formula Qinghuang Powder with in vivo effects of arsenic in patients with myelodysplastic syndrome.Chin J Inform Tradit Chin Med(Chin)2013;20:8-10.
6.Valent P,Horny H,Bennett J M,Fonatsch C,Germing U,Greenberg P,et al.Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes:consensus statements and report from a working conference.Leukemia Res 2007;31:727-736.
7.Swerdlow SH,Campo E,Harris NL,eds.WHO classification of tumours of haematopoietic and lymphoid tissues.Lyon,France:IARC;2008:88-93.
8.Greenberg PL,Tuechler H,Schanz J,Sanz G,Garcia-Manero G,SoléF,et al.Revised international prognostic scoring system for myelodysplastic syndromes.Blood 2012;120:2454-2465.
9.Tefferi A,Barosi G,Mesa RA,Cervantes F,Deeg HJ,Reilly JT,et al.International Working Group(IWG)consensus criteria for treatment response in myelofibrosis with myeloid metaplasia,for the IWG for Myelofibrosis Research and Treatment(IWG-MRT).Blood 2006;108:1497-1503.
10.Zheng XY,ed.Guidelines for the clinical research of new traditional Chinese medicine(Trial).Beijing:China Medical Science and Technology Press;2002:19-20.
11.Wang Y,Fang S,Song MM,Hu XM.Safety of Compound Qinghuang Powder in patients with myelodysplastic syndromes.Int J Tradit Chin Med(Chin)2014;36:1074-1077.
12.Wang Y,Fang S,Deng ZY,Song MM,Ma JL,Yang XP,et al.Compound Qinghuang Powder in the treatment of patients with myelodysplastic syndromes.Int J Tradit Chin Med(Chin)2015;37:1091-1095.
13.Hu XM,Tanaka S,Onda K,Yuan B,Toyoda H,Ma R,et al.Arsenic disulfide induced apoptosis and concurrently promoted erythroid differentiation in cytokine-dependent myelodysplastic syndrome-progressed leukemia cell line F-36p with complex karyotype including monosomy 7.Chin J Integr Med2014;20:387-393.
14.Hu XM,Yuan B,Tanaka S,Song MM,Onda K,Tohyama K,et al.Arsenic disulfide-triggered apoptosis and erythroid differentiation in myelodysplastic syndrome and acute myeloid leukemia cell lines.Hematology 2014;19:352-360.
15.Hu XM,Yuan B,Song MM,Onda K,Tanaka S,Toyoda H,et al.Dose-dependent biphasic effects of arsenic disulfide on differentiation and apoptosis of HL-60 cells.Curr Topics Pharmacol 2014;17:13-25.
16.Hu XM,Yuan B,Tanaka S,Zhou QB,Onda K,Toyoda H,et al.Involvement of oxidative stress associated with glutathione depletion and p38 MAPK activation in arsenic disulfide-induced differentiation in HL-60 cells.Leuk Lymphom 2014;55:392-404.
2.Hu XM,Liu F,Ma R.Application and assessment of Chinese arsenic drugs in treating malignant hematopathy in China.Chin J Integr Med 2010;16:368-377.
3.Xu S,Ma R,Hu XM,Xu YG,Yang XH,Wang HZ,et al.Clinical observation of the treatment of myelodysplastic syndrome mainly with Qinghuang Powder.Chin J Integr Med2011;17:834-839.
4.Sun SZ,Ma R,Hu XM,Yang XH,Xu YG,Wang HZ,et al.Karyotype and DNA-methylation responses in myelodysplastic syndromes following treatment with traditional Chinese formula containing arsenic.Evid Based Complement Alternat Med2012;969476.doi:10.1155/2012/969476.
5.Ma JL,Qu WW,Hu XM.Correlationship of clonal selection of treatment with arsenious compound formula Qinghuang Powder with in vivo effects of arsenic in patients with myelodysplastic syndrome.Chin J Inform Tradit Chin Med(Chin)2013;20:8-10.
6.Valent P,Horny H,Bennett J M,Fonatsch C,Germing U,Greenberg P,et al.Definitions and standards in the diagnosis and treatment of the myelodysplastic syndromes:consensus statements and report from a working conference.Leukemia Res 2007;31:727-736.
7.Swerdlow SH,Campo E,Harris NL,eds.WHO classification of tumours of haematopoietic and lymphoid tissues.Lyon,France:IARC;2008:88-93.
8.Greenberg PL,Tuechler H,Schanz J,Sanz G,Garcia-Manero G,SoléF,et al.Revised international prognostic scoring system for myelodysplastic syndromes.Blood 2012;120:2454-2465.
9.Tefferi A,Barosi G,Mesa RA,Cervantes F,Deeg HJ,Reilly JT,et al.International Working Group(IWG)consensus criteria for treatment response in myelofibrosis with myeloid metaplasia,for the IWG for Myelofibrosis Research and Treatment(IWG-MRT).Blood 2006;108:1497-1503.
10.Zheng XY,ed.Guidelines for the clinical research of new traditional Chinese medicine(Trial).Beijing:China Medical Science and Technology Press;2002:19-20.
11.Wang Y,Fang S,Song MM,Hu XM.Safety of Compound Qinghuang Powder in patients with myelodysplastic syndromes.Int J Tradit Chin Med(Chin)2014;36:1074-1077.
12.Wang Y,Fang S,Deng ZY,Song MM,Ma JL,Yang XP,et al.Compound Qinghuang Powder in the treatment of patients with myelodysplastic syndromes.Int J Tradit Chin Med(Chin)2015;37:1091-1095.
13.Hu XM,Tanaka S,Onda K,Yuan B,Toyoda H,Ma R,et al.Arsenic disulfide induced apoptosis and concurrently promoted erythroid differentiation in cytokine-dependent myelodysplastic syndrome-progressed leukemia cell line F-36p with complex karyotype including monosomy 7.Chin J Integr Med2014;20:387-393.
14.Hu XM,Yuan B,Tanaka S,Song MM,Onda K,Tohyama K,et al.Arsenic disulfide-triggered apoptosis and erythroid differentiation in myelodysplastic syndrome and acute myeloid leukemia cell lines.Hematology 2014;19:352-360.
15.Hu XM,Yuan B,Song MM,Onda K,Tanaka S,Toyoda H,et al.Dose-dependent biphasic effects of arsenic disulfide on differentiation and apoptosis of HL-60 cells.Curr Topics Pharmacol 2014;17:13-25.
16.Hu XM,Yuan B,Tanaka S,Zhou QB,Onda K,Toyoda H,et al.Involvement of oxidative stress associated with glutathione depletion and p38 MAPK activation in arsenic disulfide-induced differentiation in HL-60 cells.Leuk Lymphom 2014;55:392-404.
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