Koller C A, Miller D M
N Engl J Med. 1986 Dec 4;315(23):1433-8. doi: 10.1056/NEJM198612043152301.
We observed a dramatic improvement in the peripheral blood counts of a patient in the myeloid blast phase of chronic granulocytic leukemia after plicamycin (mithramycin) therapy of concurrent hypercalcemia. We then treated eight additional patients in the blast phase of chronic granulocytic leukemia with a combination of alternate-day plicamycin and daily hydroxyurea. All six patients with myeloid morphology at the time of blast crisis responded with a return to a chronic phase without an intervening pancytopenic period. Of three patients with lymphoid morphology at the time of treatment, only one responded (this patient had recently relapsed and converted from myeloid to lymphoid morphology). Another patient with nonmyeloid, nonlymphoid blast morphology also did not respond. Continual therapy with the two-drug combination appeared to be necessary, since early relapses were seen in responding patients whose therapy was interrupted. These data are preliminary and will need further confirmation, but they suggest that the combination of alternate-day plicamycin and daily hydroxyurea may be effective in the myeloid blast phase of chronic granulocytic leukemia.
我们观察到，一名处于慢性粒细胞白血病髓系原始细胞期的患者在接受普卡霉素（光辉霉素）治疗并发高钙血症后，外周血细胞计数有显著改善。随后，我们用隔日普卡霉素和每日羟基脲联合治疗了另外8名处于慢性粒细胞白血病原始细胞期的患者。在原始细胞危象时具有髓系形态的所有6名患者均有反应，恢复到慢性期，且无中间全血细胞减少期。在治疗时具有淋巴系形态的3名患者中，只有1名有反应（该患者最近复发并从髓系形态转变为淋巴系形态）。另一名具有非髓系、非淋巴系原始细胞形态的患者也无反应。似乎有必要持续使用这两种药物联合治疗，因为在治疗中断的有反应患者中出现了早期复发。这些数据是初步的，需要进一步证实，但它们表明隔日普卡霉素和每日羟基脲联合使用可能对慢性粒细胞白血病的髓系原始细胞期有效。
