Department of Hematology, Zhengzhou University People's Hospital.
Department of Hematology, First Affiliated Hospital, College of Clinical Medicine, Henan University of Science and Technology, Luoyang.
Medicine (Baltimore). 2021 Apr 2;100(13):e24567. doi: 10.1097/MD.0000000000024567.
Acute promyelocytic leukemia (APL) with myelofibrosis (MF) is rare, and only 14 cases have been reported in the literature to date.
A 42-year-old woman was admitted to the hospital with easy bruising and excessive bleeding. With the remission of the primary disease during treatment, the degree of fibrosis did not decrease, but worsened progressively.
The woman was diagnosed with acute promyelocytic leukemia with secondary myelofibrosis.
All-trans retinoic acid (ATRA) was discontinued after 6 months of complete remission of APL. Arsenic trioxide (ATO) was discontinued because of supraventricular tachycardia 9 months after complete remission of APL.
After withdrawal of ATRA for 2 months, the degree of fibrosis was significantly alleviated, and after withdrawal of ATRA for 8 months and ATO for 5 months, bone marrow biopsy showed no reticular fiber deposition.
In this case report and review of an additional 14 cases of APL with MF, we highlighted the importance of the degree of MF to be evaluated by bone marrow biopsy at the time of bone marrow aspiration when APL is suspected. If MF is present, the type of MF should be determined in a timely manner, and appropriate intervention measures should be taken accordingly.
伴骨髓纤维化（MF）的急性早幼粒细胞白血病（APL）较为罕见，迄今为止，文献中仅报道了 14 例。
一名 42 岁女性因易瘀伤和过度出血而入院。在治疗过程中，随着原发病的缓解，纤维化程度不仅没有降低，反而逐渐加重。
该女性被诊断为伴继发性骨髓纤维化的急性早幼粒细胞白血病。
APL 完全缓解 6 个月后停用全反式维甲酸（ATRA）。APL 完全缓解 9 个月后因室上性心动过速停用三氧化二砷（ATO）。
停用 ATRA 2 个月后，纤维化程度明显缓解，停用 ATRA 8 个月和 ATO 5 个月后，骨髓活检未见网状纤维沉积。
在本病例报告和对另外 14 例伴 MF 的 APL 病例的回顾中，我们强调了在怀疑 APL 时，通过骨髓抽吸时的骨髓活检评估 MF 程度的重要性。如果存在 MF，应及时确定 MF 的类型，并采取相应的干预措施。
