Itoh K, Gotoh W, Yagasaki F, Itoh Y, Kawai N, Matsuda A, Tominaga K, Kusumoto S, Ino H, Murohashi I, Jinnai I, Takeuchi H, Bessho M, Hirashima K
First Department of Internal Medicine, Saitama Medical School.
Rinsho Ketsueki. 1998 Mar;39(3):221-6.
A 56-year-old man was admitted to our hospital in September, 1996. Chromosomal translocation (15; 17) and a PT-PCR study for PML-RAR alpha mRNA were positive in bone marrow aspirates, and acute promyelocytic leukemia was diagnosed. After CR was obtained with all-trans retinoic acid (ATRA) followed up with chemotherapy, the RT-PCR became negative. When he was readmitted in April, 1997, skin eruption on his chest and extremities were observed. Specimens taken for biopsy revealed leukemia cutis, and RT-PCR became positive in the same specimen. Bone marrow PT-PCR was also positive without abnormal promyelocytes. Although he was treated with oral ATRA 80 mg/day again, no significant improvement in leukemia cutis was noted. After combined therapy with Ara-C and acularubicin, skin eruption disappeared and bone marrow RT-PCR became negative. A second CR was then obtained. Although it is unknown whether the administration of ATRA is related to extramedullary relapse or not, we recommend combined chemotherapy for such cases.
一名56岁男性于1996年9月入院。骨髓穿刺染色体易位（15；17）及PML-RARα mRNA的PT-PCR检测呈阳性，诊断为急性早幼粒细胞白血病。经全反式维甲酸（ATRA）诱导缓解并序贯化疗后，RT-PCR转为阴性。1997年4月再次入院时，发现其胸部及四肢出现皮疹。活检标本显示为皮肤白血病，同一标本的RT-PCR转为阳性。骨髓PT-PCR也呈阳性，但未见异常早幼粒细胞。尽管再次给予口服ATRA 80mg/日治疗，皮肤白血病未见明显改善。采用阿糖胞苷和阿克拉霉素联合治疗后，皮疹消失，骨髓RT-PCR转为阴性，再次获得完全缓解。虽然ATRA的使用是否与髓外复发有关尚不清楚，但我们建议对此类病例采用联合化疗。
