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All - trans Retinoic Acid 가 급성전골수성백혈병의 관해유도와 혈액응고장애에 미치는 효과
김성권(Sung Gwon Kim),한치화(Chi Wha Han),김유진(Yoo Jin Kim),김동욱(Dong Wook Kim),진종률(Jong Youl Jin),민우성(Woo Sung Min),박종원(Chong Won Park),김춘추(Choon Choo Kim),김동집(Dong Jip Kim) 대한내과학회 1997 대한내과학회지 Vol.53 No.2
N/A Objectives: APL, which characteristically shows t(15:17), accompanies fatal coagulopathy during remission induction with systemic chemotherapy alone. ATRA, a derivative of vitamin A, can differentiate APL cells as well as HL-60 cells in vitro and induce higher rate of complete remission(CR). Hence, we assessed the effect of ATRA on remission induction and coagulopathy in APL patients. Methods: (1) 42 patients diagnosed histologically in St. mary's hospital from June 1991 to June 1994 were included. (2) We compared the CR rate, the time required for restoration of derranged coagulation profiles, and the amount of coagulation factors including platelets among the chemotherapy group (control) and ATRA group. Results: 1) There was no difference in CR rate between the control group and ATRA group [84.2%(16 out of 19) vs 87.0%(20 out of 23), p>0.05)] and also no difference between two subgroups of ATRA [ATRA with chemotherapy; 83.3%(10 out of 12) vs ATRA without chemotherapy; 90.9%(10 out of 11), p>0.05] 2) In the ATRA group, the CR rate of newly diagnosed patients was 82.4%(14 out of 17). The first relapsed patients (4) and the second (2) were all achieved CR. 3) The mean duration of coagulopathy, time to normalization of PT, aPTT, FDP, fibrinogen level, was 12.0±10.4, 11.1±10.2, 16.5±9.3, 15.4±10.2 days after chemotherapy alone and 4.5±4.4, 3.7±3.7, 8.9±6.1, 8.1±6.5 days in the ATRA group(p<0.05). The amount of fresh frozen plasma used in the ATRA group for the purpose of correction of coagulopathy were significantly lower than the control group(p<0.05). The incidence of profound coagulopathy during the remission induction treatment in the ATRA group was significantly lower than the control group[40% (8 out of 20) vs 96.7%(13 out of 15), p<D.05]. And the amount of platelet transfusion was not different between two groups. 4) During the treatment with ATRA, four patients showed leukocytosis, but no patient developed typical retinoic acid syndrome. Other toxicities attributable to ATRA were headache in one case, increase in transaminase in one case, bone pain in one case. These side effects were mostly short-term and easily controlled by appropriate symptomatic therapy. Conclusion: (1) ATRA is relatively safe drug for inducing CR in patients with APL who are diagnosed freshly and even in relapse. (2) Also it is effective for reducing the severity of coagulopathy associated with APL itself.
저골수 충실성 급성 골수성 백혈병의 치료방침 화학 요법과 골수이식
김영균(Young Kyoon Kim),노진탁(Jin Tark Nho),박은영(Eun Young Park),한치화(Chi Wha Han),박종원(Chong Won Park),김춘추(Choon Choo Kim),김동집(Dong Jip Kim),한경자(Kyung Ja Han),김원일(Won Il Kim) 대한내과학회 1988 대한내과학회지 Vol.35 No.6
N/A There have been a few repots of acute myelogenous leukemia (AML) presenting hypocellular bone marrow. Most physicians are reluctant to give these patients intensive chemotherapy because of the potential risk of serious bone marrow failure. We experienced 10 patients with hypocellular AML (HAML) that could be difined by the criteria of 30% or more atypical blasts and 50% or less cellularity in the bone marrow. There were six men and four women and their ages ranged from 20 to 67 years. Various regimens including low dose ara-C alone (4 cases) and low dose ara-C with modified TAD (1case), with mitoxanthrone (1 case) or with mithramycin (1 case) were applied. Of the remaming three patlents; one received supportive care only, another mithramycin alone and the third allogeneic bone marrow transplantation. As a result, the three cases who received either allogeneic bone marrow transplantation or low dose ara-C with modified TAD or that with mitoxanthrone entered into complete remission. However, only the patient who received allogeneic bone marrow transplantation is still alive. The duration of survival ranged from 2 months to 18 months; the median was 8 months. One of the most common complications during chemotherapy was severe bone marrow suppression and the major cause of death was various severe infections during the pancytopenic period. Though the most favorable therapy for HAML is still controversial, bone marrow transplantation is considered to be the choice of treatment at the present time for young patients with HLA-identical donors. If bone marrow transplantation is not available, a more aggressive form of therapy in addition to low dose ara-C will be preferable.