论文部分内容阅读
目的 :探讨全反式维甲酸治疗急性早幼粒细胞白血病过程中维甲酸综合征的临床特点及其治疗。方法 :对于初治的 15 4例 APL 患者 ,ATRA治疗后 ,白细胞小于 2 0× 10 9/ L 者单用ATRA治疗 ,白细胞大于 2 0× 10 9/ L 者加用化疗 ,治疗前白细胞大于 2 0× 10 9/ L 者 ATRA与化疗同时应用。结果 :14例 APL 患者发生 RAS。临床症状出现的中位时间为 7天 ,主要症状为发热 ,呼吸困难 ,低氧血病 ,肺部浸润等。 14例 RAS患者至少有以上 3种症状。 13例因白细胞增高化疗 ,5例ATRA减量 ,7例停用 ATRA,患者均加用大剂量糖皮质激素 ,12例 RAS患者 CR,2例死亡。未发生RAS患者 CR率为 89%。获得缓解后的 RAS患者继续用 ATRA维持治疗无 RAS再发生。结论 :APL 初诊时白细胞高 ,应用 ATRA后白细胞升高过快、过高者易发生 RAS,应立即加用化疗和糖皮质激素治疗
Objective: To investigate the clinical characteristics and treatment of retinoic acid syndrome in the treatment of acute promyelocytic leukemia with all-trans retinoic acid. Methods: ATRA treatment of 154 newly diagnosed APL patients after treatment with ATRA, leukocytes less than 20 × 10 9 / L were treated with ATRA alone, leukocytes greater than 20 × 10 9 / L plus chemotherapy, pre-treatment leukocytes greater than 2 0 × 10 9 / L ATRA and chemotherapy at the same time. Results: RAS occurred in 14 APL patients. The median time to clinical symptoms was 7 days. The main symptoms were fever, dyspnea, hypoxemia, pulmonary infiltrates and the like. Fourteen patients with RAS had at least the above three symptoms. Thirteen patients received chemotherapy with leukocytosis, five patients with ATRA reduction and seven patients with ATRA discontinuation. All patients were treated with high-dose glucocorticosteroid, 12 patients with RAS were treated with CR, and 2 patients died. The CR rate in patients without RAS was 89%. Patients with remission after RAS continue to be treated with ATRA without recurrence of RAS. Conclusion: APL newly diagnosed high white blood cells, leukocytes after ATRA increased too fast, too prone to RAS, should immediately add chemotherapy and glucocorticoid therapy