全反式维甲酸治疗急性早幼粒细胞白血病的严重副反应

Severe side effects of the treatment of acute promyelocytic leukemia with all-trans retinoic acid

采用全反式维甲酸 (ATRA)治疗急性早幼粒细胞白血病 (APL) 6 3例 ,其高白细胞综合征、高颅压综合征及维甲酸综合征的发生率分别为 5 7.1% ,9.5 %和 3.2 % ;其死亡率为 11.1% ;高白细胞综合征导致白细胞壅滞是死亡的原因。笔者建议 :ATRA治疗APL时 ,当白细胞在第 6天 >5 .0× 10 9·L- 1 ,第 10天 >10 .0× 10 9·L- 1 ,第 15天 >15 .0× 10 9·L- 1 时应加用高三尖杉酯碱治疗 ;当患者的白细胞在ATRA治疗前≥ 10 .0× 10 9·L- 1 ,则先单用高三尖杉酯碱 ,待白细胞下降至≤ 5 .0× 10 9·L- 1 ,再加用维甲酸治疗 ;一旦发生维甲酸综合征则应停用维甲酸 。

Sixtythree cases with acute promyelocytic leukemia (APL) were treated with alltrans retinoic acid (ATRA). The rates of hyperleukocytosis, intracranial hypertension, retinoic acid syndrome were 57.1%,9.5%,and 3.2% respectively. Mortality of the treatment was 11.1%. Under ATRA treatment, hyperleukocytosis leading to leukostasis was the cause of death in patients with APL. We therefore suggest that the patients with such leukocyte levels (that is,5.0×109·L -1 on the 6th day, 10.0×109·L -1 on the 10th day, 15.0×109·L -1 on the 15th day) can be used as guidelines for starting chemotherapy(homoharringtonine); before ATRA treatment, while leukocyte counts are >10×109·L -1 , the patients only receive homoharringtonine;when leukocyte counts are≤5.0×109·L -1 , the patients receive a combination of homoharringtonine and ATRA. Retinoic acid syndrome is a distinctive complication of ATRA therapy in the patients with APL. While the syndrome occurs, the treatment of ATRA must be stopped and corticosteroids must be used. [