Robak T
Kliniki Hematologii AM w Lodzi.
Acta Haematol Pol. 1995;26(3):269-77.
All-trans-retinoic acid (ATRA, tretinoin) is a natural metabolite of retinol and is normally found in plasma, at concentrations of approximately 0.5-1.5 ng/ml. The in vivo and in vitro studies has demonstrated that in pharmacological doses it can differentiate leukemic cells in acute promyelocytic leukemia (APL). ATRA has been shown to induce complete remission (CR) rates of approximately 90% in newly diagnosed and first relapsing APL. However, CR induced by ATRA alone are usually not sustained and intensive antileukemic consolidation therapy is required to prolong remission. ATRA followed by intensive chemotherapy has improved the outcome of newly diagnosed APL, by increasing the CR rate and by reducing the risk of relapse. The presence of the PML/retinoic acid receptor-alpha (PML/RAR-alpha) fusion gene is a marker for sensitivity to this agent. ATRA therapy is associated with the risk of rapidly rising leukocyte counts, leading to the retinoid acid syndrome which may be fatal if the increase in leukocytes is not reversed. A side effects from these complications ATRA therapy is generally well tolerated.
全反式维甲酸（ATRA，维甲酸）是视黄醇的天然代谢产物，通常存在于血浆中，浓度约为0.5 - 1.5 ng/ml。体内和体外研究表明，在药理剂量下，它可以使急性早幼粒细胞白血病（APL）中的白血病细胞分化。ATRA已被证明在新诊断和首次复发的APL中诱导完全缓解（CR）率约为90%。然而，单独使用ATRA诱导的CR通常不能持久，需要强化抗白血病巩固治疗来延长缓解期。ATRA联合强化化疗通过提高CR率和降低复发风险，改善了新诊断APL的治疗结果。PML/维甲酸受体α（PML/RAR-α）融合基因的存在是对该药物敏感的标志物。ATRA治疗与白细胞计数迅速上升的风险相关，可导致维甲酸综合征，如果白细胞增加不能逆转，可能会致命。这些并发症引起的副作用，ATRA治疗一般耐受性良好。
