一名急性早幼粒细胞白血病患者在使用三氧化二砷进行再诱导治疗期间发生骨髓坏死。

Bone marrow necrosis in a patient with acute promyelocytic leukemia during re-induction therapy with arsenic trioxide.

作者信息

Ishitsuka Kenji, Shirahashi Akihiko, Iwao Yasuhiro, Shishime Mikiko, Takamatsu Yasushi, Takatsuka Yoshifusa, Utsunomiya Atae, Suzumiya Junji, Hara Syuji, Tamura Kazuo

机构信息

1st Department of Internal Medicine, Fukuoka University, Fukuoka, Japan.

出版信息

Eur J Haematol. 2004 Apr;72(4):280-4. doi: 10.1111/j.0902-4441.2003.00206.x.

DOI:10.1111/j.0902-4441.2003.00206.x

PMID:15089767

Abstract

Arsenic trioxide (As2O3) therapy at a daily dose of 0.15 mg/kg was given to a 60-yr-old Japanese male with refractory acute promyelocytic leukemia. White blood cell (WBC) of 6.6 x 10(3)/microl increased to 134 x 10(3)/microl following the administration of As2O3. Daily hydroxyurea (HU), and 6-mercaptopurine (6-MP) were added on days 7 and 19, respectively. Both HU and 6-MP were discontinued on day 28, when WBC declined to 54.0 x 10(3)/microl. He developed unexplained fever and profound cytopenia requiring multiple blood products transfusions. Bone marrow examination on day 42 revealed massive necrosis. Pharmacokinetics confirmed a mean maximum plasma arsenic concentration (Cpmax) and a half-life time (t1/2) of 6.9 microm and 3.2 h, respectively, in the therapeutic range. This is the first case of bone marrow necrosis after standard-dose As2O3 therapy.

摘要

一名60岁的日本男性难治性急性早幼粒细胞白血病患者接受了每日剂量为0.15 mg/kg的三氧化二砷（As2O3）治疗。给予As2O3后，白细胞（WBC）从6.6×10³/微升增加至134×10³/微升。分别在第7天和第19天加用了每日羟基脲（HU）和6-巯基嘌呤（6-MP）。当WBC在第28天降至54.0×10³/微升时，HU和6-MP均停用。他出现了不明原因的发热和严重血细胞减少，需要多次输注血液制品。第42天的骨髓检查显示大量坏死。药代动力学证实，在治疗范围内，平均最大血浆砷浓度（Cpmax）和半衰期（t1/2）分别为6.9微摩尔和小时。这是标准剂量As2O3治疗后发生骨髓坏死的首例病例。