Tsurumi H, Yamada T, Sawada M, Nakamura N, Takahashi T, Moriwaki H, Muto Y
First Department of Internal Medicine, Gifu University School of Medicine.
Rinsho Ketsueki. 1995 Jun;36(6):582-8.
We evaluated the effect of treatment by all-trans retinoic acid (ATRA) in 9 patients with acute promyelocytic leukemia (APL). Of 6 patients who had circulating leukemic blasts before treatment, 3 initially received ATRA alone but died of respiratory failure due to retinoic acid syndrome (RAS). High dose steroid therapy did not rescue RAS in these patients. Another 3 who were given intensive chemotherapy followed by ATRA and/or granulocyte colony-stimulating factor (G-CSF) achieved complete remission (CR). Of 3 patients without peripheral leukemic blasts before treatment, 1 received intensive chemotherapy followed by G-CSF and reached CR, 1 who had been previously given ATRA did not respond to ATRA, and 1 did not initially respond sufficiently to ATRA alone but responded dramatically to ATRA plus G-CSF. In the treatment of APL, appropriate combination of ATRA, G-CSF and chemotherapy should always be taken into consideration. In addition, RAS have to be carefully avoided when applying ATRA therapy in patients who have circulating leukemic blasts before treatment.
我们评估了全反式维甲酸（ATRA）对9例急性早幼粒细胞白血病（APL）患者的治疗效果。在6例治疗前有循环白血病原始细胞的患者中，3例最初仅接受ATRA治疗，但因维甲酸综合征（RAS）死于呼吸衰竭。高剂量类固醇疗法未能挽救这些患者的RAS。另外3例接受强化化疗后再给予ATRA和/或粒细胞集落刺激因子（G-CSF）的患者获得了完全缓解（CR）。在3例治疗前无外周血白血病原始细胞的患者中，1例接受强化化疗后再给予G-CSF并达到CR，1例先前已接受ATRA治疗，对ATRA无反应，1例最初单独使用ATRA反应不充分，但对ATRA加G-CSF反应显著。在APL的治疗中，应始终考虑ATRA、G-CSF和化疗的适当联合应用。此外，在对治疗前有循环白血病原始细胞的患者应用ATRA治疗时，必须谨慎避免RAS的发生。
