Takagi S, Yoshikawa H, Akao Y, Hiraiwa A, Sao H, Yoshikawa S
Gan To Kagaku Ryoho. 1982 Nov;9(11):2038-45.
A case of erythroleukemia coexistent with pulmonary emphysema is reported. A 67-year-old male was admitted to our hospital in May 1981, with a few year history of cough, sputum and fatigue. He had already been diagnosed as having pulmonary emphysema and moderate anemia. On physical examination, except for pallor, no other findings were remarkable. The initial hematological examination showed hemoglobin, 9.6 g/dl, red cell count, 251 x 10(4)/microliters, platelet count, 7.3 x 10(4)/microliters, white cell count, 2600/microliters with neither myeloblasts nor erythroblasts. A sternal marrow aspiration revealed 21% myeloblasts and 40% erythroblasts including 7.5% megaloblastoids. Periodic Acid Schiff staining was strongly positive for a part of erythroblasts. A chest X-P finding was typical for pulmonary emphysema. Pulmonary function was moderately damaged. He was started on chemotherapy with AAAP (ACNU 50 mg/d i.v. drip over 4 hr x 4d, adriamycin 20 mg/d i.v. push x 4d, Methotrexate 20 mg i.v. push x 4d). The first course of AAAP brought him a complete remission with both disappearance of myeloblasts and erythroid precursors with megaloblastoid nuclei in the marrow and the normalization of white cell count and platelet count in the blood. He was discharged in September 1981 after completion of a consolidation chemotherapy with AAAP. Since then, he received two courses of AAAP as an intensification chemotherapy and has been in complete remission for more than 13 months. His pulmonary function has not been affected and no myocardial damage has been seen throughout AAAP therapy. Thus, AAAP therapy seems to be an excellent chemotherapy even for an aged patient with erythroleukemia.
报告了一例红白血病合并肺气肿的病例。一名67岁男性于1981年5月入住我院，有数年咳嗽、咳痰及乏力病史。他已被诊断为肺气肿和中度贫血。体格检查时，除面色苍白外，无其他明显异常。最初的血液学检查显示血红蛋白9.6g/dl，红细胞计数251×10⁴/微升，血小板计数7.3×10⁴/微升，白细胞计数2600/微升，未见原始粒细胞和早幼红细胞。胸骨骨髓穿刺显示21%原始粒细胞和40%早幼红细胞，其中包括7.5%巨幼样变细胞。部分早幼红细胞的过碘酸希夫染色呈强阳性。胸部X线检查结果为典型的肺气肿表现。肺功能中度受损。开始用AAAP方案化疗（环己亚硝脲50mg/d静脉滴注4小时×4天，阿霉素20mg/d静脉推注×4天，甲氨蝶呤20mg静脉推注×4天）。AAAP方案的第一个疗程使他完全缓解，骨髓中原始粒细胞和具有巨幼样核的红系前体细胞消失，血液中白细胞计数和血小板计数恢复正常。1981年9月在完成AAAP巩固化疗后出院。此后，他接受了两个疗程的AAAP强化化疗，已完全缓解超过13个月。在整个AAAP治疗过程中，他的肺功能未受影响，也未见心肌损伤。因此，即使对于老年红白血病患者，AAAP疗法似乎也是一种很好的化疗方法。
