全反式维甲酸治疗急性早幼粒细胞白血病60例

TREATMENT OF ALL-TRANS RETINOIC ACID IN 60 CASES WITH ACUTE PROMYELOCYTIC LEUKEMIA

目的：总结全反式维甲酸（ATRA）治疗急性早幼粒细胞白血病（APL）经验，探讨如何降低治疗中的早期死亡率。方法：选择60例确诊为APL的患者，采用ATRA治疗。结果：53例（883％）达完全缓解。29例（483％）出现白细胞增多症，9例出现高白细胞综合征，加用小剂量三尖杉酯碱、羟基脲或米托蒽醌，8例症状消失。6例出现维甲酸综合征，使用甲基强的松龙或地塞米松并用小剂量ATRA治疗后4例好转。结论：早期识别ATR毒副作用，尽早治疗，可以降低APL患者早期死亡率。

objective: To conclude experiences of treatment in acute promyelocytic leukemia(APL) with all-trans retinoic acid(ATRA) and to discuss how to reduce mortality of APL during treatment. Methods: Sixty patients with APL were selected to be treated with ATRA. Results: 53 cases (88. 3%)achieved complete remission. 29 cases (48. 3%) developed leukooytosis and among them 9 developed hyperleukocytosis syndrome, which cleared up in 8 after having been treated with low-dose harringtonine or mitoxantrone or hydroxyurea in addition to ATRA. Six patients developed retinoic acid syndrome (RS), which subsided after administration of methylprednisolone or dexamethasone with a lower dose of ATRA in four patients. Conclusion: Earlier recognition and appropriate treatment of hyper-leukocytosis and retinoic acid syndrome can reduce the mortality of APL during ATRA therapy.