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The paper reported that the use of all-trans retinoic acid (RA) in the inducing differentiation therapy in 9 patients with APL.RA 20mg 3-4/d was taken orally every day until complete remission (CR).Seven cases (77.8%) obtained CR.The time of continuous therapy with RA till CR was 20-39 days,mean 31±7.5 days;the total amount of RA taken till CR was 1.20-2.96g,mean 2.01±0.63g.Two cases obtained partial remission (PR).In one of them PR occurred on the 29th day of RA therapy,but repeated examination of BM showed... The paper reported that the use of all-trans retinoic acid (RA) in the inducing differentiation therapy in 9 patients with APL.RA 20mg 3-4/d was taken orally every day until complete remission (CR).Seven cases (77.8%) obtained CR.The time of continuous therapy with RA till CR was 20-39 days,mean 31±7.5 days;the total amount of RA taken till CR was 1.20-2.96g,mean 2.01±0.63g.Two cases obtained partial remission (PR).In one of them PR occurred on the 29th day of RA therapy,but repeated examination of BM showed morphologic mutation of leukemic cells into ANLL (M2a),with 78% of myeloblasts.Then we used chemotherapy of HOAP program but failed,and the patient died from sepsis.The other had suffered from hepatitis with jaundice two years ago,which relapsed on the 18th day of RA therapy,and the patient died from it.The dynamic change of leukocyte count,differential and platelet counts,the prevention and therapy for complications such as DIC and infections,and side reactions in the course of RA therapy were discussed. 报告应用全反式维甲酸诱导分化治疗急性早幼粒白血病(APL)9例。每天口服维甲酸(RA)20mg3~4/d,至取得完全缓解(CR)为止。获得CR 7例(77.8%),至取得GR时间为20~39天,平均31±7.5天,至取得CR时,RA使用的总剂量为1.2~2.96g,平均2.01±0.63g。部分缓解(PR)者2例,其中1例入院诊断为ANLL(M3b),治疗第29天获PR,但骨髓复查显示白血病细胞形态变异,转化为ANLL(M2a),原始粒细胞78%,改用HOAP方案再化疗无效,并发败血症死亡;另1例RA治疗第18天获PR,但此时2年前患的黄疸型肝炎复发,因此死亡。讨论了RA治疗过程病人周围血白细胞计数、分类和血小板恢复正常的动力学变化,以及DIC、感染和副反应的防治。 By immunogold technique the intracytoplasmic lysozyme content and distribution were analysed in 8 cases with acute promyelocytic leukemia (APL). The majority of granules in leukaemic cells lacked lysozyme activity, though hyperactive production of primary granules occurred. However, in some rather immature leukaemic cells were detected 1ysozyme-positive granules. In remission after the retinoic acid treatment intracytoplasmic granules exhibited frequently positivity for lysozyme with the maturation of leukaemic... By immunogold technique the intracytoplasmic lysozyme content and distribution were analysed in 8 cases with acute promyelocytic leukemia (APL). The majority of granules in leukaemic cells lacked lysozyme activity, though hyperactive production of primary granules occurred. However, in some rather immature leukaemic cells were detected 1ysozyme-positive granules. In remission after the retinoic acid treatment intracytoplasmic granules exhibited frequently positivity for lysozyme with the maturation of leukaemic cells. It was confirmed that there existed abnormality of the granule components in APL cells besides overproduction of primary granules. The result suggested that the measurement of intracytoplasmic lysozyme might be helpful to judge the effect of induced differentiation therapy for APL. 本研究应用胶体金免疫电镜技术,观察了8例颗粒增多的急性早幼粒细胞白血病细胞内溶菌酶的分布及含量。观察中发现早幼粒白血病细胞中尽管有大量的初级颗粒生成,但这些颗粒多数缺乏溶菌酶活性,而少数形态较原始的白血病细胞中却查见溶菌酶阳性颗粒。维甲酸治疗后,细胞形态趋于成熟,细胞中颗粒常表现为溶菌酶阳性反应。本观察显示急性早幼粒细胞白血病不仅颗粒生成亢进,颗粒中组成成份也发生异常;并提示白血病细胞中溶菌酶活性的测定,对于判断诱导分化治疗白血病的疗效具有一定的参考价值。 16 cases of acute promyelocytic leukemia(APL)treated with differentiation induction by all-trans retinoic acid(RA)were reported in the present paper.80%(13/16 cases)patients developed disseminated intra- vascular coagulation(DIC)at the admission and/or in the course of treat- ment,25%(4/16 cases)severe hemorrhage.All patients received by synthetical treatment including low dose heparin,fresh blood and platelets transfu- sion,dexamethasone,dehydration and antibiotics,which ensured effectively to RA brought into... 16 cases of acute promyelocytic leukemia(APL)treated with differentiation induction by all-trans retinoic acid(RA)were reported in the present paper.80%(13/16 cases)patients developed disseminated intra- vascular coagulation(DIC)at the admission and/or in the course of treat- ment,25%(4/16 cases)severe hemorrhage.All patients received by synthetical treatment including low dose heparin,fresh blood and platelets transfu- sion,dexamethasone,dehydration and antibiotics,which ensured effectively to RA brought into play role of differentiation induction.All patients achieved complete remission in the bone marrow. 16例急性早幼粒细胞性白血病(APL)采用全反式维甲酸(RA)进行诱导分化治疗。入院时和病程中80%(13/16例)的患者发生弥散性血管内凝血(DIC),4例发生严重出血。经配合包括肝素抗凝、新鲜血及血小板输注,并用地塞米松、脱水和防治感染等积极的综合性治疗,渡过危险期,有效保障 RA 诱导分化作用的发挥,全部病例取得骨髓完全缓解.
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