| 397 | 12 | 14 |
| 下载次数 | 被引频次 | 阅读次数 |
目的:进一步探讨全反式维甲酸(ATRA)所致维甲酸综合征(RAS)的临床特征。方法:回顾分析9例出现RAS的急性早幼粒细胞白血病的患者的临床表现、治疗与预后。结果:RAS发生时间在ATRA治疗后3~28天(中位11天)。9例发热,7例呼吸困难,4例可闻及肺部湿罗音,4例胸水,2例心包积液,5例腹水,5例下肢浮肿,3例出现尿量减少,其中1例发展成为尿毒症。9例出现至少3种上述症状。经过地塞米松治疗,减量或停用ATRA,加用化疗及对症支持治疗,RAS状均可改善。7例白血病达完全缓解,1例因颅内出血死亡。结论:RAS临床表现较为严重,需积极采用激素及相应治疗。
Abstract：Objective:To further explore the clinical features of all-trans retinoic acid(ATRA) caused retinoic acid syndrome(RAS).Methods:The clinical manifestations,treatment and prognosis of 9 acute promyelocytic leukemia(APL) patients with RAS were retrospectively studied.Results:Patients receiving ATRA for induction developed RAS at a median time of 11 days of ATRA (range 3-28).Fever (all of the 9 patients),respiratory distress(7/9),pulmonary infiltrates(4/9),pleural effusion(4/9),pericardial effusion(2/9),celiac effusion(5/9),crura edema(5/9),and urine decrease(3/9)were the main clinical signs.With treatment of dexamethasone,ATRA decreasing or withdraw,with or without chemotherapy,most clinic sings resolved.Seven patients got complete remission,one died of intracranial bleeding.Conclusion:RAS is a servere syndrome which need active therapy.
[1]De Botton S,Coiteux V,Chevret S,et al.Outcome of childhood a-cute promyelocytic leukemia with all-trans-retinoic acid and chemotherapy[J].J Clin Oncol,2004,22(8):1404-1412.
[2]Tallman MS,Andersen JW,Schiffer CA,et al.Clinical description of44patients with acute promyelocytic leukemia who developed the retinoic acid syndrome[J].Blood,2000,95(1):90-95.
[3]任新萍,王德炳,付剑峰,等.全反式维甲酸治疗急性早幼粒细胞白血病并发维甲酸综合征七例临床分析[J].中华内科学杂志,1998,37(6):416.
[4]张之南主编.血液病诊断及疗效标准(第2版)[M].北京:科学出版社,1998.171-218.
[5]Frankel SR,Eardley A,Lauwers G,et al.The“retinoic acid syn-drome”in acute promyelocytic leukemia[J].Ann Intern Med,1992,117(7):292-296.
[6]De Botton S,Dombret H,Sanz M,et al.Incidence,clinical fea-tures,and outcome of all trans-retinoic acid syndrome in413ca-ses of newly diagnosed acute promyelocytic leukemia[J].Blood,1998,92(8):2712-2718.
[7]Gupata V,Yi QL,Brandwein J,et al.Role of all-trans-retinoic acid(ATRA)in the consolidation therapy of acute promyelocytic leukaemia(APL)[J].Leuk Res,2005,29(1):113-114.
[8]Ninomiya M,Kiyoi H,Ito M,et al.Retinoic acid syndrome in NOD/scid mice induced by injecting an acute promyelocytic leu-kemia cell line[J].Leukemia,2004,18(3):442-448.
[9]Ko BS,Tang JL,Chen YC,et al.Extramedullary relapse after all-trans retinoic acid treatment in acute promyelocytic leukemia-the occurrence of retinoic acid syndrome is a risk factor[J].Leukemi-a,1999,13(9):1406-1408.
[10]De Botton S,Chevret S,Coiteux V,et al.Early onset of chemo-therapy can reduce the incidence of ATRAsyndrome in newly di-agnosed acute promyelocytic leukemia(APL)with low white blood cell counts:results from APL93trial[J].Leukemia,2003,17(2):339-342.
基本信息:
中图分类号:R733.7
引用信息:
[1]卢瑞南,李建勇,盛瑞兰,等.全反式维甲酸治疗急性早幼粒细胞白血病合并维甲酸综合征的临床研究[J].临床肿瘤学杂志,2005(06):584-586.
2005-12-25
2005-12-25