Escudier S M, Kantarjian H M, Estey E H
Department of Hematology, Leukemia Section, University of Texas M.D. Anderson Cancer Center, Houston, USA.
Leuk Lymphoma. 1996 Feb;20(5-6):435-9. doi: 10.3109/10428199609052425.
Laboratory evidence of disseminated intravascular coagulation (DIC) and/or fibrinolysis is present in the majority of patients with acute promyelocytic leukemia (APL). Historically, early hemorrhagic death (EHD) occurred in 10% to 30% of patients treated with chemotherapy. All-trans retinoic acid (ATRA), a differentiating agent, has a CR rate above 80% in patients, with ATRA-associated leukocytosis. We studied thrombotic events in this population and compared it to patients treated with chemotherapy alone. The results of studies using ATRA in patients with APL were reviewed. Patients received ATRA 45-50 mg/m(2) orally in two divided doses daily until complete remission. In newly diagnosed patients, Idarubicin 12 mg/m(2)/day was given intravenously for 4 to 5 days beginning on the fifth day of ATRA therapy or when the white blood cell count (WBC) was over 10x 10(3)/mu l. Thrombotic complications were noted in 3 of 31 patients during induction. Two died from thrombotic events during therapy with multiple thromboses documented at autopsy. ATRA syndrome was suspected in 2 of the patients with thromboses and only 1 of the patients without thrombosis. In previous studies, 1 of 25 APL patients treated with chemotherapy alone had thrombotic events during therapy. In conclusion, treatment of APL with ATRA may decrease the incidence of hemorrhagic complications, but does not eliminate thrombosis. While thrombotic events were not significantly increased in patients treated with ATRA, they were more common in patients suspected of having ATRA syndrome.
大多数急性早幼粒细胞白血病（APL）患者存在弥散性血管内凝血（DIC）和/或纤维蛋白溶解的实验室证据。从历史上看，接受化疗的患者中有10%至30%会发生早期出血性死亡（EHD）。全反式维甲酸（ATRA）作为一种分化剂，在伴有ATRA相关白细胞增多症的患者中完全缓解率超过80%。我们研究了该人群中的血栓形成事件，并将其与仅接受化疗的患者进行比较。回顾了在APL患者中使用ATRA的研究结果。患者每天分两次口服ATRA 45 - 50 mg/m²，直至完全缓解。对于新诊断的患者，从ATRA治疗的第五天或白细胞计数（WBC）超过10×10³/μl开始，静脉给予伊达比星12 mg/m²/天，持续4至5天。诱导期间31例患者中有3例出现血栓并发症。2例在治疗期间死于血栓形成事件，尸检记录有多发性血栓。3例血栓形成患者中有2例怀疑发生了ATRA综合征，无血栓形成的患者中只有1例怀疑发生了ATRA综合征。在先前的研究中，25例仅接受化疗的APL患者中有1例在治疗期间发生血栓形成事件。总之，用ATRA治疗APL可能会降低出血并发症的发生率，但不能消除血栓形成。虽然接受ATRA治疗的患者血栓形成事件没有显著增加，但在怀疑患有ATRA综合征的患者中更为常见。
