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报道1例耐全反式维甲酸(ATRA)的急性早幼粒细胞白血病患者采用丹参酮ⅡA治疗后缓解的病例。患者,男,30岁。无诱因觉头昏、乏力半月,左足拇指刺伤后出血不止伴发热7d,当地医院抗感染热退,但余症不减而入院诊治。体检贫血貌,巩膜无黄染;双下肢皮肤散在出血点与紫癜。胸骨下端压痛,心肺未见异常。肝、脾、淋巴结无肿大。血常规示白细胞计数(WBC)2.3×109/L,Hb60g/L,血小板计数34×109/L,原幼细胞0.85;骨髓增生极度活跃,其中早幼粒细胞0.89,过氧化物酶染色强阳性;APTT和PT均延长,FDP和D-二聚体阳性。诊断为急性早幼粒细胞白血病(APL)伴DIC。ATRA20mgtid治疗12周及分别20mgbid和10mgbid各1周(共14周)未缓解,改为丹参酮ⅡA30mgbid治疗,8周后外周血恢复正常,治疗12周骨髓恢复正常,达到完全缓解(CR)。用丹参酮A维持治疗3月余复发,后经高三尖杉酯碱和阿糖胞苷(HA)诱导治疗再次CR。3年后第二次复发后死于颅内出血。丹参酮ⅡA治疗耐ATRA的APL有效,未见不良反应;但CR后仅用其维持治疗仍可能复发。
Reported a case of patients with acute promyelocytic leukemia resistant to all trans retinoic acid (ATRA) treated with tanshinone Ⅱ A. Patient, male, 30 years old. No incentive causes dizziness, fatigue half a month, left foot thumb bleeding after injury more than fever with fever 7d, the local hospital anti-infective fever retreat, but not reduce the remaining illness and hospitalized. Physical examination anemic appearance, Sclera no yellow dye; Bleeding point of both lower extremity skin and purpura. Lower sternal tenderness, no abnormal heart-lung. Liver, spleen, lymph nodes without swelling. Blood count showed white blood cell count (WBC) 2.3 × 109 / L, Hb60g / L, platelet count 34 × 109 / L, primordial cells 0.85; myeloproliferation extremely active, promyelocytic 0.89, strongly positive peroxidase staining ; APTT and PT were extended, FDP and D-dimer positive. Diagnosed with acute promyelocytic leukemia (APL) with DIC. ATRA 20mgtid 12 weeks and 20mgbid and 10mgbid respectively for 1 week (14 weeks) did not relieve, to tanshinone Ⅱ A30mgbid treatment, 8 weeks after the peripheral blood returned to normal, 12 weeks after the bone marrow returned to normal, to achieve complete remission (CR). With tanshinone A maintenance treatment of more than three months recurrence, after homoharringtonine and cytarabine (HA) induction therapy again CR. 3 years after the second relapse died of intracranial hemorrhage. Tanshinone IIA treatment of ATRA-resistant APL effective, no adverse reactions; but only after CR maintenance therapy may still relapse.