全反式维甲酸治疗急性早幼粒细胞白血病中的致命性副作用

Fatal side effects of acute promyelocytic leukemia in the treatment of all trans retinoic acid

用全反式维甲酸（ＡＴＲＡ）治疗８２例急性早幼粒细胞白血病（ＡＰＬ），其中３５例（４２７％）出现白细胞增多症，２２例（２６８％）出现致命性副作用。后者包括维甲酸综合征１５例，颅内出血７例。提示：在ＡＴＲＡ治疗ＡＰＬ过程中，白细胞增多是致命性副作用发生的重要危险因素；ＡＴＲＡ与小剂量三尖杉酯碱相结合，可降低因白细胞增多导致颅内出血的发生率；肾上腺皮质激素能显著降低维甲酸综合征的死亡率。

Of 82 patients with acute promyelocytic leukemia(APL) who were treated with all trans retinoic acid(ATRA), 35 developed leukocytosis and 22 fatal side effects(15 with retinoic acid syndrome and 7 intracranial bleeding). There was a high mortality in the patient with fatal side effects. The relationship between leukocytosis and fatal side effects was analyzed and the effect of therapeutic interventions on the development and prognosis of the fatal side effects was investigated. The results showed that leukocytosis was a risk factor of the development of fatal side effects in APL treated with ATRA. ATRA combined with small dose of harringtonine in treating APL can reduce the incidence of intracranial bleeding resulted from leukocytosis and corticosteroid can decrease the mortality of retinoic acid syndrome.