Objective To assess the clinical effectiveness and safety of inductive treatment with arsenic trioxide （As203） for acute promyelocytic leukemia （APL）. Methods Randomized controlled trials （RCTs） were identified from MEDLINE （1966 -July, 2005 ）, EMBASE （1984 -July, 2005 ）, The Cochrane Library （ Issue 3, 2005） and CBM- disc （1978 -July, 2005）. The references of eligible studies were handsearched. RCTs of As203 treating for APL were included. Data were evaluated and extracted by two reviewers independently with designed extraction form. RevMan 4. 2.7 software was used for data analysis. Results Six RCTs involving 323 patients were included. Two studies reported that there was no statistical difference between As2O3 group and all-transretinoic acid （ATRA） group in mortality for patients with APL or APL patients with complications of desseminated intiavascular coagulation or cerebra hemorrhage. The pooled result of 4 studies showed that there was no statistical difference with RR 0.98, 95 % CI 0.86 to 1.12 in complete remission （CR） rates between the two groups. The result of one study showed that the CR rate of patients with intravenous injection of As203 in 2 divided dosages with longer injection duration was higher with RR 1.31, 95% CI 0.86 to 1.12 compared with those with a single intravenous injection. Adverse effects in As2O3 group were less than ATRA group. Conclusions Inductive treatment with As2O3 for acute promyelocytic leukeuia has similar mortality and CR with less adverse effects compared with ATRA. More trials of high quality are required.
Objective To systematically review the effectiveness and safety of arsenic trioxide (ATO) versus retinoic acid for patients with acute promyelocytic leukemia (APL). Methods Such databases as PubMed, The Cochrane Library (Issue 12, 2012), CNKI, WanFang Data and VIP were electronically and comprehensively searched from inception to December 2012, for randomized controlled trials (RCTs) on the effectiveness and safety of ATO versus retinoic acid for patients with APL. Two reviewers independently screened literature according to the inclusion and exclusion criteria, extracted data, and assessed methodological quality. Then, meta-analysis was performed using RevMan 5.0.2 software. Results Eight RCTs involving 586 cases of APL patients. The results of meta-analysis showed that, ATO and all-trans-retinoic (ATRA) were not statistically different in CR rates (OR=0.85, 95%CI 0.54 to 1.35, P=0.50), CR time (OR=–8.14, 95%CI –16.42 to 0.13, P=0.05), recurrence rates (OR=0.14, 95%CI 0.02 to 1.21, P=0.07), early mortality (OR=0.82, 95%CI 0.32 to 2.06, P=0.67), and five-year total survival rates (OR=1.19, 95%CI 0.54 to 2.60, P=0.66). ATO had lower incidences of adverse reaction such as hyperleukocytosis syndrome (OR=0.32, 95%CI 0.18 to 0.58, P=0.000 1) and retinoic acid syndrome (OR=0.05, 95%CI 0.02 to 0.14, Plt;0.000 01). Conclusion ATO and ATRA are alike in CR rates, CR time, recurrence rates, early mortality, and five-year total survival rates, but ATO causes less adverse reaction. Due to the limited quantity and quality of the included studies, ATO should be applied with caution according to patients’ conditions in clinic.
ObjectiveTo observe the clinical characteristics of children with leukemia combined with ocular fundus lesions, and analyze the related risk factors. MethodsA retrospective clinical study. A total of 126 children with leukemia who were diagnosed and underwent fundus examination in Hunan Children's Hospital, from February 2022 to June 2025 were included. Posterior pole fundus images of both eyes were obtained using a handheld non-mydriatic fundus camera. Optical coherence tomography and fluorescein fundus angiography were performed when necessary. Outcomes were analyzed on a per-patient basis. Fundus involvement was defined as the presence of abnormalities in either eye, and the main lesion type was classified according to the more severe eye. According to the presence or absence of fundus lesions, the patients were divided into the lesion group (38 cases, 30.15%, 38/126) and non-lesion group (88 cases, 69.85%, 88/126). Differences in age, sex distribution, hematological parameters, and leukemia subtype were compared between the two groups. Binary logistic regression was used to identify independent risk factors. ResultsAmong the 126 children, 66 were male and 60 were female. The mean age was (7.62±3.13) years. Seventy-eight patients had acute lymphoblastic leukemia, and 48 patients had acute myeloid leukemia , including 11 patients with acute promyelocytic leukemia (APL). Compared with the non-lesion group, the lesion group had a significantly higher peripheral blood white blood cell count (WBC) level and significantly lower hemoglobin and platelet levels, with statistically significant differences (t=8.210, ?6.940, ?11.040; P＜0.05). Among the 38 patients with fundus lesions, retinal hemorrhage was observed in 28 cases (73.68%, 28/38), optic disc edema in 6 cases (15.79%, 6/38), cotton-wool spots in 3 cases (7.89%, 3/38), and choroidal lesions in 1 case (2.63%, 1/38). Multivariate logistic regression analysis showed that WBC count, per 10×109/L increase [odds ratio (OR)=2.13, 95% confidence interval (CI) 1.35-3.41, P=0.002], early-stage chemotherapy (OR=1.96, 95%CI 1.12-3.15, P=0.010), and APL subtype (OR=2.74, 95%CI 1.28-5.89, P=0.008) were independent risk factors for fundus lesions. ConclusionsFundus lesions are relatively common in children with leukemia and are predominantly characterized by hemorrhagic changes. Elevated WBC count, per 10×109/L increase, early-stage chemotherapy, and APL subtype indicate a high risk of fundus involvement.