Abe Y, Takatsuki H, Okada Y, Yufu Y, Kimura T, Nishimura J, Nawata H, Oshima K, Kikuchi M
Department of Internal Medicine, Nakabaru Hospital.
Rinsho Ketsueki. 1996 Dec;37(12):1395-9.
A 48-year-old female was admitted to our hospital because of pancytopenia and pneumonia in February, 1993. The increase of abnormal promyelocytes with t (15; 17) and PML-RAR mRNA was detected in bone marrow aspirate and a diagnosis of acute promyelocytic leukemia was made. She obtained complete remission after the administration of all-trans retinoic acid (ATRA) and following chemotherapy. Then she received peripheral blood stem cell transplantation in September, 1993. However she noticed a umbilical tumor in June, 1995. Abnormal promyelocytes were demonstrated not only in bone marrow aspirate but also in the umbilical tumor. Because of the poor response to ATRA and development of fever, a side effect of ATRA, G-CSF and prednisolone were administrated together with ATRA. After the combined therapy, umbilical tumor disappeared and she obtained complete remission again. These findings suggest that combined therapy of ATRA and G-CSF is effective to the low responder to ATRA and that combined use of ATRA and prednisolone reduces the side effect of ATRA without diminishing the favorable effect on differentiation.
1993年2月，一名48岁女性因全血细胞减少和肺炎入住我院。骨髓穿刺检查发现存在伴有t(15;17)和PML-RAR mRNA的异常早幼粒细胞增多，确诊为急性早幼粒细胞白血病。她在接受全反式维甲酸（ATRA）及后续化疗后获得完全缓解。1993年9月，她接受了外周血干细胞移植。然而，1995年6月她发现脐部有肿物。骨髓穿刺及脐部肿物均发现有异常早幼粒细胞。由于对ATRA反应不佳且出现发热（ATRA的副作用），在使用ATRA的同时加用了G-CSF和泼尼松龙。联合治疗后，脐部肿物消失，她再次获得完全缓解。这些结果表明，ATRA与G-CSF联合治疗对ATRA低反应者有效，且ATRA与泼尼松龙联合使用可减少ATRA的副作用，同时不减弱其对分化的有利作用。
