Notario A, Rolandi M L, Mazzucchelli I
Institute of Medical Therapy, University of Pavia, Italy.
Haematologica. 1996 May-Jun;81(3):261-4.
The aim of the present study was to better understand the possibility of utilizing growth factors of the myelomonocytic line in acute leukemias. The study is an examination of morphological changes and marker behavior in peripheral and bone marrow cells in AML and APL during treatment both with all-transretinoic acid (ATRA) alone and in association with chemotherapy and G-CSF. The same treatment was carried out in a patient who had been diagnosed with Vaquez's disease 15 years earlier and currently presented a bone marrow and peripheral picture of AML (80% myeloblasts) with thrombocytopenia. We observed that treatment with ATRA, alone or in association with chemotherapy, was followed by a remission of AML and especially of APL, with amelioration of the general condition of the patients. The addition of G-CSF to ATRA at the end of chemotherapy, during consequent pancytopenia, produced a rapid increase in mature peripheral granulocytes and an apparent medullary complete remission, which was more prolonged in APL than in AML; there was no increase in peripheral blasts. Discontinuation of G-CSF was followed by a relapse in the patient with AML. A patient with Vaquez's disease, in remission for 15 years and presenting a progressive increase in bone marrow and peripheral myeloblasts, did not have a positive response to the administration of ATRA; however, the association of G-CSF to ATRA was followed by a complete remission. The morphological changes observed in bone marrow and peripheral granulocytes (with changes in the main cellular markers: CD11b, CD13, CD14, CD15, CD34) seemed to express progressive modification of the single elements towards differentiation, with progressive bone marrow reduction and peripheral disappearance of blasts. The data agree with the changes observed in in vitro blasts cultured in the presence of ATRA and G-CSF.
本研究的目的是更好地了解在急性白血病中利用髓单核细胞系生长因子的可能性。该研究是对急性髓系白血病（AML）和急性早幼粒细胞白血病（APL）患者在单独使用全反式维甲酸（ATRA）治疗以及与化疗和粒细胞集落刺激因子（G-CSF）联合治疗期间外周血和骨髓细胞的形态变化及标志物行为的检查。对一名15年前被诊断为真性红细胞增多症、目前呈现AML骨髓和外周血图像（80%原粒细胞）并伴有血小板减少症的患者进行了同样的治疗。我们观察到，单独使用ATRA或与化疗联合使用ATRA治疗后，AML尤其是APL出现缓解，患者的一般状况得到改善。在化疗结束后全血细胞减少期间，在ATRA中添加G-CSF可使成熟外周粒细胞迅速增加，并出现明显的骨髓完全缓解，APL的缓解期比AML更长；外周血原始细胞没有增加。停用G-CSF后，AML患者复发。一名真性红细胞增多症患者缓解15年，骨髓和外周血原粒细胞逐渐增加，对ATRA给药无阳性反应；然而，ATRA与G-CSF联合使用后出现完全缓解。在骨髓和外周粒细胞中观察到的形态学变化（主要细胞标志物CD11b、CD13、CD14、CD15、CD34发生变化）似乎表明单个细胞成分逐渐向分化方向改变，骨髓逐渐减少，外周血原始细胞消失。这些数据与在ATRA和G-CSF存在下培养的体外原始细胞中观察到的变化一致。
