初发急性早幼粒细胞性白血病老年患者诊治全过程1例报告及文献复习  

Analysis a case of elderly newly diagnosed acute promyelocytic leukemia and a review of the literature

作　　者：王传馥[1] 张洪娣[1] 潘祖玉[1] 俞卓伟[1] 

机构地区：[1]上海市老年医学研究所,上海市200040

出　　处：《老年医学与保健》2013年第1期21-25,共5页Geriatrics & Health Care

摘　　要：目的报导初发APL老年患者对ATRA联合ATO加化疗的疗效并结合文献讨论。方法采集病史，书写病程演进，作辅助检查，进行PML—RARu,融合基因检测和随访。记录治疗方案、并发症、药物不良反应及处理经过。结果本例AML—RARa融合基因阳性。采用ATRA联合ATO加化疗方案。经诱导、巩固和维持等3阶段治疗，住院5m，巩固治疗结束后，获MR。全程治疗32m完成。并发症主要是肺部感染，处理要及时，支持治疗要重视。药物治疗的计量应掌握在成人的2／3-3／4。结论老年APL患者能够耐受ATRA联合ATO加化疗并取得良好的疗效。Objective To observe the efficacy of all-trans retinoic acid （ATRA） and IV arsenic trioxide （ATO） plus chemotherapy regimens for a elderly patient with acute promyelocytic leukemia （APL）. Methods a 71-year-old man with newly diagnosed APL, for induction, oral ATRA 60mg/d, and intravenous ATO 10mg/d, starting on day 1 and con- tinuing until CR; idarubicin （ IDA ） and cytarabine （ Ara-C ） was added to induction treatment. Achieved hematologic and medullary complete remission（ hCR and mCR ）, the patient treated with 3 consolidation courses. Coursel ： homoharringtonine 2mg/d, daysl-5 combined with Ara-C 100mg/d, daysl-5. Course2~ 3： IDA10mg/d, daysl-3 combined with Ara-C 100mg/d, days1-3. The patients in molecular CR after 3 consolidation courses, bone marrow （BM） samples were assayed by quantitative RT-PCR for PML-RARA fusion transcripts is negative. Followed by nine courses maintenance therapy, each course of treatment for 3 months, a total of 27 months. Nine courses divided in two stages to carry on, the first stage include five courses （ sequential regimen, ml. intravenous ATO10mg/d, daysl-10; m2： oral ATRA 30mg/d, days1-30; m3： intravenous Methotrexate （MTX） 5mg, qw^4w ） and the second stage include four courses （sequential regimen, ml： oral ATRA 30mg/d, daysl-30; m2： oral MTX 15mg, qwx4w; m3： oral 6-mercaptopurine （6-MP） 50mg/d, daysl-14 ）. Results The 71-year-old patient with APL （moderate risk ） administered ATRA, IV ATO and chemotherapy in combination was achieved molecular CR and continuing molecular CR more than 52 months. During the therapy, the patient suffered from the adverse events included pneumonia, hydrothorax, hepatic disfunction, herpes zoster, atrial premature beats and fibrillation atrial, etc. Treatment should be timely, and should pay more attention to support measures. For patients aged 〉 70 years, the doses should be appropriately reduced. Condusion Ederly patient with APL may be tol- erant to ATRA combined with ATO plus chemot

关 键 词：急性早幼粒细胞性白血病 老年人 全反式维甲酸 亚砷酸 

分 类 号：R733.7[医药卫生—肿瘤]