Tanaka Y, Komatsu H, Ishii K, Nakamura F, Hayashi T, Sawada H, Ono Y, Imanaka T
Department of Hematology, Tenri Hospital.
Rinsho Ketsueki. 2000 Apr;41(4):354-7.
It has been shown that arsenic trioxide (As2O3) may induce hematologic remissions in patients with acute promyelocytic leukemia (APL) refractory to all-trans retinoic acid (ATRA). We reported on a patient with ATRA and drug-resistant APL that was successfully treated with As2O3. The patient had been given a diagnosis of typical APL and was treated with ATRA and chemotherapy for 12 months. He achieved complete remission (CR), but leukemia relapsed with 43% APL cells in the bone marrow in the 16th month of treatment. ATRA and cytarabine plus daunorubicin were administered; however, the APL cells in the bone marrow increased to 97.2%. As2O3 was initiated intravenously, and bone marrow showed a decrease of APL cells (6.7%) and a partial differentiation after 9 days. The patient received idarubicin (IDA) and steroid pulse because of the development of ATRA-like syndrome, and achieved CR 37 days after the initiation of As2O3. He received an additional 2 courses of As2O3 with IDA, and is in CR. These results demonstrated the therapeutic efficacy of As2O3 in treating ATRA and drug-resistant APL.
已有研究表明，三氧化二砷（As2O3）可使对全反式维甲酸（ATRA）难治的急性早幼粒细胞白血病（APL）患者获得血液学缓解。我们报告了1例ATRA耐药的APL患者，其经As2O3治疗获得成功。该患者被诊断为典型APL，接受ATRA和化疗12个月。他获得了完全缓解（CR），但在治疗第16个月时白血病复发，骨髓中APL细胞占43%。给予ATRA及阿糖胞苷加柔红霉素治疗；然而，骨髓中APL细胞增至97.2%。开始静脉给予As2O3，9天后骨髓显示APL细胞减少（6.7%）并出现部分分化。由于出现类似ATRA的综合征，该患者接受了去甲氧柔红霉素（IDA）和类固醇冲击治疗，并在开始使用As2O3后37天获得CR。他又接受了2个疗程含IDA的As2O3治疗，目前处于CR状态。这些结果证明了As2O3治疗ATRA耐药APL的疗效。
