急性早幼粒细胞白血病全反式维甲酸诱导分化中的高危并发症及其处理

Acute promyelocytic leukemia: hyperleukocytosis in differentiation therapy with all-trans retinoic acid

53例初诊急性早幼粒细胞白血病（APL）采用全反式维甲酸（ATRA）治疗，发生白细胞增多（≥20×109／L）58％（31／53例），维甲酸综合征7．4％（4／54例次）。5例（9．4％）早期死亡，3例有白细胞增多。高白细胞组（高白组）9例并用DA或HA方案化疗。非高白细胞组（非高白组）与高自组的完全缓解（CR）率分别为100％（19／19例）及96．3％（26／27例）。化疗为目前对白细胞增多症主要的针对性治疗，综合性治疗对减低早期死亡仍居重要地位。

Fifty-three cases of newly diagnosed APL were treated with all-trans retinoic acid (ATRA). Hy-perleukocytosis (>20×109/L) were caused by ATRA during inducing differentiation therapy in 58% (31/53cases)- Retinoic acid syndrome appeared for 7. 4 % (4 cases of 54 patients), one case of RAS occured two episodes during initial remission induction therapy and antirelapse treatment. Five cases (9. 4 % ) died early at 4~ 10th day after beginning of treatment, three of them were associated with hyper1eukocytosis. Nine patients of hyperleukocy-tosis group were combined with chemotherapy of HA or DA. complete remission rates of non-hyperleukocytosis group and hyperleukocytosis group were 100% (19/19 cases) and 96. 3 % (26/27 cases )respectively. Chemotherapy is the ma jor effective approach to treat patients with hyperleukocytosis- Synthetic scheme of treatment still plays the most important role in decreasing early death.