[Analysis of empirical treatment for newly diagnosed acute promyelocytic leukemia combined with disseminated intravascular coagulation].
This study was aimed to explore the clinical characteristics and optimal therapeutic methods for newly diagnosed acute promyelocytic leukemia (APL) combined with disseminated intravascular coagulation (DIC) so as to guide the clinical therapy. The clinical date and therapeutic outcome of 25 cases of APL combined with DIC treated from January 2008 to March 2013 in our department were analysed retrospectively. The 25 patients were given ATRA 20 mg orally twice a day and arsenic trioxide (ATO) 10 mg intravenously once a day to induce differentiation therapy, the chemotherapy was added after degranulation of promyelocytes. At the same time the platelets, fresh frozen plasma, fibrinogen, cryoprecipitate,prothrombin complex and amino methylbenzoic acid, low molecular weight heparin were given to treat DIC. According to the laboratorial examination of coagulation and fibrinolysis, the medication was adjusted.The white blood cell count, platelet level, prothrombin time (PT), partial thromboplastin time of plasma (APTT), fibrinogen level were detected, and the relation of those factors and age with bleeding severity was analyzed by multivariate manner. The results showed that among 25 patients with APL (low-risk 5 cases, intermediate risk 13 cases and high risk 7 cases), 22 cases combined with DIC, incidence of DIC was 88%. Out of 22 patients with DIC 21 patients (95.5%) were corrected, except 1 case death. After the first course of treatment, 23 cases (92%) gained complete remission (CR) with average CR time 31.8 ± 7.2 days. During the induction of CR, the average platelet transfusion level was 75.68 ± 55.88 U, the RBC level was 8.90 ± 5.69 U, the average level of fresh frozen plasma transfusion of APL patients with DIC was 21.92 ± 19.32 U. The recovery time of platelet level to normal was 29.3 ± 9.3 days, the recovery time of PT, APTT, FDP and fibrinogen to normal were 12.7 ± 9.5 days, 11.6 ± 8.6 days, 16.0 ± 9.3 days and 125.3 ± 85.3 days respectively. The multivariate analysis showed that WBC count at onset was >10 × 10(9)/L and APTT was prolonged. These two factors were main reasons resulting in severe bleeding. It is concluded that the newly diagnosed APL always combined with DIC, therefore in the early phase of disease active transfusion of blood products, application of anti-coagulation and anti-fibrinolytic drugs as well as heparin should be performed; the coagulation function should be as soon as recovered to normal so as to early correct DIC. These measures can significantly decrease the mortality of APL patients resulting from DIC. The hyperleukocytosis and prolonged APTT are the main factors for severe bleeding.
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Hua
H
Yang
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Cheng-Ying
CY
Zhu
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Quan-Shun
QS
Wang
Department of Hematology and Oncology, The Forth People's Hospital of Jinan City, Jinan 250031, Shandong Province, China.
Jian-Hua
JH
Niu
Department of Hematology, People's Hospital of Gaochun, Nanjing 211300, Jiangsu Province, China.
Qi
Q
Zhang
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Hai-Yan
HY
Zhu
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Zi-Long
ZL
Yao
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China.
Yuan-Yuan
YY
Xu
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China. E-mail: jingyu301@126.com.
Yu
Y
Jing
Department of Hematology, Chinese PLA General Hospital, Beijing 100853, China. E-mail: chunhuiliyu@yahoo.com.
Li
L
Yu
D000293:Adolescent; D000328:Adult; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D001803:Blood Transfusion; D004211:Disseminated Intravascular Coagulation / Q000150:complications / Q000628:therapy*; D005260:Female; D006801:Humans; D015473:Leukemia, Promyelocytic, Acute / Q000150:complications / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D055815:Young Adult