Marshall Shoko, Imada Hiroshi, Kimura Ayako, Ito Toshimasa, Ogasawara Toshie, Kazama Hiroshi, Yoshinaga Kentaro, Tanaka Junji, Uchigata Yasuko, Ogawa Tetsuya
Department of Medicine, Tokyo Women's Medical University, Adachi Medical Center.
Pharmaceutical Department, Tokyo Women's Medical University, Adachi Medical Center.
Rinsho Ketsueki. 2023;64(3):193-197. doi: 10.11406/rinketsu.64.193.
All-trans retinoic acid (ATRA) is used as standard induction therapy for acute promyelocytic leukemia (APL), but it is contraindicated for patients on hemodialysis. We present a case of a patient with APL on hemodialysis, intubated, and with marked disseminated intravascular coagulation (DIC) who was successfully treated with ATRA. A 49-year-old man was transferred to our hospital and admitted into the intensive care unit due to renal dysfunction, DIC, and pneumonia. Promyelocytes were noted in the peripheral blood, and he was diagnosed with APL after bone-marrow examination. Because of renal dysfunction, only Ara-C was used but with a reduced dose. The patient's condition improved, and he was extubated and withdrawn from dialysis on the 5 day of hospitalization. The patient suffered from APL syndrome during induction therapy, which necessitated ATRA withdrawal and steroid administration. Remission was achieved after induction therapy, and the patient is currently on maintenance therapy. There are few cases of patients with APL on hemodialysis who were treated with ATRA; hence, it is necessary to review the treatment plan for these patients.
全反式维甲酸（ATRA）被用作急性早幼粒细胞白血病（APL）的标准诱导治疗药物，但对于接受血液透析的患者是禁忌的。我们报告了一例接受血液透析、插管且伴有明显弥散性血管内凝血（DIC）的APL患者，该患者接受ATRA治疗后获得成功。一名49岁男性因肾功能不全、DIC和肺炎被转至我院并入住重症监护病房。外周血中发现早幼粒细胞，经骨髓检查后诊断为APL。由于肾功能不全，仅使用了小剂量的阿糖胞苷。患者病情改善，住院第5天拔除气管插管并停止透析。患者在诱导治疗期间出现APL综合征，需要停用ATRA并给予类固醇治疗。诱导治疗后实现缓解，患者目前正在接受维持治疗。接受血液透析的APL患者接受ATRA治疗的病例很少；因此，有必要重新审视这些患者的治疗方案。
