急性早幼粒细胞白血病并发中枢神经系统浸润

The Clinic Research of (APL) Acute Promyelocytic Leukemia Accompanying Central Nervous Systematic (CNS)Infiltration

目的 探讨急性早幼粒细胞白血病 (APL)合并中枢神经系统 (CNS)浸润的临床特征和防治措施。方法 对 2 32例APL患者中 17例合并CNS浸润病例进行临床回顾分析。结果 APL合并CNS浸润的发生率为 7.3%。 12例发生在缓解后的治疗阶段 ,3例仅有CNS的髓外复发而无骨髓复发。 4例先出现CNS浸润后骨髓复发。 5例骨髓复发后 1～ 3个月相继发生CNS浸润。 17例中 3例在缓解 6 0个月后出现CNS浸润。对 17例CNS浸润患者采用MTX +Ara -C +DX鞘内注射、全脑放疗和全身化疗后 ,11例获得了再次缓解(6 4 .7% )。 3年生存 7例 (4 1.2 % ) ,生存 5年以上 4例 (2 3.5 % )。结论 APL合并CNS浸润的发生率较高 ,完全缓解 (CR)后应重视和加强对CNS浸润的防治 ;采用MTX +Ara -C +DX鞘内注射、全脑放疗和全身化疗 。

Objective To discuss the clinic features and prevention means of acute promyelocytic leukemia (APL) accompanying central nervous systematic (CNS) infiltration.Methods 17 cases of 232 APL cases with CNS infiltration were reviewed and analyzed.Results The rate of APL with CNS infiltration was 7.3%. CNS infiltration may take place in any stage of APL treatment period. 2 of them shew firstlg as CNS infiltration. 5 of them took place in the stage of induction remission.12 of them took place in the stage of complete remission period. 3 cases with CNS infiltration shew relapse without bone marrow infiltration. 4 cases shew CNS infiltration at first and then relapse in bone marrow. CNS infiltration took place with 5 cases after their relapse in bone marrow for one to three months.3 of 17 cases shew CNS infiltration after 60 month remission. MYX+Ara-C+DX intrathecal injection ,brain radiotherapy and whole body chemotherapy method were adopted, in 17 cns infiltration ceses 11 of them gained remission again(64.7%), 7 cases were in the stage of complete remission(41.2%). Of which 4 cases lived more than 5 years(23.5%); 10 cases died and 1 case dropped out in the visit.Conclusions Adopting MTX+Ara-C+DX intrathecal injection, brain radiotherapy and whole body chemotherapy method is one of the effective measures in treating APL with CNS infiltration.