Ishitsuka Kenji, Shirahashi Akihiko, Iwao Yasuhiro, Shishime Mikiko, Takamatsu Yasushi, Takatsuka Yoshifusa, Utsunomiya Atae, Suzumiya Junji, Hara Syuji, Tamura Kazuo
1st Department of Internal Medicine, Fukuoka University, Fukuoka, Japan.
Eur J Haematol. 2004 Apr;72(4):280-4. doi: 10.1111/j.0902-4441.2003.00206.x.
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.
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。
