成人高白细胞急性白血病95例的临床分析

Clinical manifestation and treatment of 95 adult patients with hyperleukocytic acute leukemia

本文报告初诊时外周血白细胞数等于或大于100×10~9/L成人急性白血病93例的临床及治疗结果。显示,在确诊后的14天内,易发生致死性颅内出血,且常见于其血小板数仍高于10×10~9/L(10～58×10~9/L),凝血-抗凝血指标正常者。本组患者完全缓解率(46.9％)与同期治疗的702例非商白细胞急性白血病患者的(57.6％)相似,但中位生存时间较短,且与其白细胞数呈负相关。高龄、肝和(或)脾肿大、中枢神经系统和肺、肾等白血病细胞侵犯以及骨髓中白血病细胞高值均对急性非淋巴细胞白血病疗效有不利影响。此外,对诱导化疗失败的类型作了讨论。

The natural history and their response to treatment of 95 cases of acute leukemia with pretreatment leukocyte count of 100×10°/L or higher were reviewed to identify the clinical features and characteristic responses to treatment. It was characterized by a high incidence of fatal intracranial hemorrhage during the first 14 days of diagnosis. The hemorrhage usually occurred when the platelet count remained greater than 10×10~9/L, ranging around 10~58×10~9/L while the pretreatment coagulation or anticoagulation index was normal. The complete remisson rate of 46.9% was close to that of patients with lower leukocyte count in the same period, the median survival duration was shorter and inversely related to the initial leukocyte count. Patients with ANLL who faild to obtain remisson were comparatively old in age and had a higher prevalence of hepatomegaly and(or) splenomegaly, infiltration of leukemia cells into the central nervous system, kidneys, pulmonary leukostasis with a high percentage of blasts in the bone marrow. The adverse prognostic features for HAL and causes of failure in initial remisson induction in HAL were analyzed.