Azuno Y, Hiroshige Y, Tanaka M, Nishimura Y, Tanaka H, Ueda K, Nishimura M, Okafuji K, Seguchi M, Yoshida T
Third Department of Internal Medicine, Yamaguchi University School of Medicine, Ube.
Rinsho Ketsueki. 1992 Apr;33(4):445-50.
A 14-year-old girl with acute promyelocytic leukemia (APL) developed cardiomyopathy following chemotherapy for remission induction and subsequent consolidation consisting of cumulative doses of 644 mg/m2 of daunorubicin and 31 mg/m2 of mitoxantrone. Six months after the first complete remission, when relapse of APL was recognized an allogeneic bone marrow transplantation (BMT) from her HLA-identical brother was performed. A preconditioning regimen, consisting of cytarabine (Ara-C, 2 g/m2/day x 3 days and 4 g/m2/day x 3 days), total body irradiation (TBI, 1200 cGy) and etoposide (VP-16, 50 mg/kg) caused moderate gastrointestinal symptoms and transient hemorrhagic cystitis, but did not worsen her cardiac function. Both continuous intravenous administration of heparin to control DIC and continuous low dose dopamine infusion to prevent cardiac failure achieved their purpose. The patient is leukemia-free and has no symptoms related to cardiomyopathy at the eight month after BMT. A preconditioning regimen (Ara-C, TBI and VP-16) appeared to be suitable for BMT to a patient with anthracycline-induced cardiomyopathy.
一名14岁急性早幼粒细胞白血病（APL）女孩在接受诱导缓解及后续巩固化疗后出现心肌病，化疗累积剂量为柔红霉素644 mg/m²及米托蒽醌31 mg/m²。首次完全缓解6个月后，当APL复发时，接受了来自其HLA匹配哥哥的异基因骨髓移植（BMT）。预处理方案包括阿糖胞苷（Ara-C，2 g/m²/天×3天和4 g/m²/天×3天）、全身照射（TBI，1200 cGy）和依托泊苷（VP-16，50 mg/kg），该方案引起了中度胃肠道症状和短暂性出血性膀胱炎，但未使她的心脏功能恶化。持续静脉输注肝素以控制弥散性血管内凝血（DIC）以及持续低剂量多巴胺输注以预防心力衰竭均达到了目的。在BMT后8个月，患者白血病已治愈，且无心肌病相关症状。预处理方案（阿糖胞苷、TBI和VP-16）似乎适用于对蒽环类药物诱导的心肌病患者进行BMT。
