VAD方案治疗ALL伴发高白细胞综合征(病例报道并文献复习)  

USING VAD TO TREAT ALL ACCOMPANY WITH HYPERLEUKOCYTOSIS (A CASE REPORT AND LITERATURE REVIEW)

作　　者：蔡浩彦[1] 施红[1] 刘方旭[1] 顾惜春[1] 常乃柏[1] 

机构地区：[1]北京医院,北京100730

出　　处：《白血病．淋巴瘤》2003年第6期338-341,共4页Journal of Leukemia & Lymphoma

摘　　要：目的 :报道 1例初诊急性淋巴细胞性白血病 (AL L)患者合并弥漫性血管内凝血(DIC)及高白细胞综合征 ,经 VAD方案化疗并及时纠正 DIC治疗后完全缓解 (CR) ,并进行文献复习。方法 :1例初诊 AL L 患者 ,4 1岁男性 ,诊断时伴有高白细胞综合征多脏器浸润 (WBC392× 1 0 9/ L)DIC、低氧血症、大量腹水及心肌酶、尿酸明显升高 ,骨髓穿刺 :增生极度活跃 ,原 +幼淋 89.5 % ,提示AL L。入院后立即予 VAD方案化疗 ,同时水化、碱化尿液、利尿 ,小剂量肝素持续静点及间断输注纤维蛋白原纠正 DIC。结果 :患者临床症状明显好转 ,血象、凝血功能、D-二聚体、肝、肾功能、血气、心肌酶等亦逐渐恢复正常 ,复查骨髓示 :原 +幼淋占 1 % ,AL L- CR。结论 :VAD方案中大剂量激素可达到快速减低肿瘤负荷的目的 ,且激素不引起大量肿瘤细胞崩解 ,较少发生溶瘤综合征。对高白细胞性AL LObjective:To report a case of newly diagnosed acute lymphatic leukemia (ALL) accompany with hyperleukocytosis and DIC acquired CR after treated with VAD.Methods:A patient with ALL accompany with hyperleukocytosis (WBC 392×10 9/L),DIC,hypoxemia,ascites,dysfunction of liver and kidney etc was treated with VAD chemotherapy. At the same time, we also gave the therapy that can control the symptoms only. These include hydration, urinary alkalinization, allopuninol, continuous intravenous use of low dose heparin etc.Results:The patient acquired CR finally, the clinical symptoms disappeared and laboratory tests returned normal.Conclusion:VAD chemotherapy is a good choice for ALL accompany with hyperleukocytosis.

关 键 词：急性淋巴细胞性白血病 DIC 高白细胞综合征 VAD 诊断 化疗 

分 类 号：R733.7[医药卫生—肿瘤]