(A) clinical study of acute promyelocytic leukemia
1969년 5월부터 1975년 6월까지 연세대학교 의과대학 부속 세브란스병원 내과에 입원한 급성 전골수구성 백혈병 환자 13예를 대상으로 임상적 고찰을 하여 다음과 같은 결과를 얻었다.
급성 백혈병중 APL의 빈도는 6.5%였고 남녀비는 2.3:1, 연령은 대부분 20대였다. 초반증상으로는 출혈이 가장 많았고(10예), 간비대 및 비장비대는 각각 3예에서 있었다. 말초혈액 소견상 심한 빈혈과 혈소판감소증이 대부분 있었고 전골수구는 평균 29.8%였고, 골수검사상 전골수구는 72.8%였다. 혈중 섬유소원치는 측정한 s4예 모두 정상범위였다. 화학요법에 대한 효과는 없었으며 사망이 확인된 6예중 4예의 사망원인이 뇌출혈이었고, 초반증상이 발생하여 사망할때까지의 평균기간은 52일이었다.
Here presented a clinical study of 13 cases of acute promyelocytic leukemia, admitted to the Dept. of Internal Medicine, Yonsei Medical Center during the period from May 1969 to June 1975.
Among the acute leukemias of the granulocytic group, acute promyelocytic leukemia is characterized by the severe hemorrhage, the frequent occurrence of hypofibrinogenemia, a rapidly fatal course, and an unusual cellular hyperplasia. Myelograms show an increased proportion (average 80%) of characteristic cells of large diameter, with numerous azurophilic granules. The infiltration of other organs is inconstant.
This study was attempted to review the sex and age distribution incidence among acute leukemia, initial symptoms, hematologic findings, chemotherapeutic response, and clinical courses in patients with acute promyelocytic leukemia.
The results obtained are as follows:
1. The incidence of acute promyelocytic leukemia was 6.5% of all cases of acute leukemia (199 cases).
2. The male to female ratio was 2.3:1. The majority of the patients were in the 2nd decade(5/13).
3. The bleeding tendency was a major symptom in 10 (76.9%), fever and chilling in 6 (46.2%), dizziness and pallor in 4 (30.8%), and easy fatigability in 1 among the 13 cases.
4. Hepatomegaly and splenomegaly were present in 3 respectively and there was no case demonstrating lymphadenopathy.
5. Pheripheral blood study revealed severe anemia and thrombocytopenia with 6.8 gm % of hemoglobin and 21,000/mm**3 platelet count on the average. The blast was 5.7% and promyelocyte 29.8%.
6. On bone marrow study, M/E ratio was 45:1, blast 3.9%, promyelocyte 72.8% on the average.
7. Blood fibrinogen levels checked in 4 cases were normal. Bleeding and coagulation times were also normal in 3 except 1 case in which the bleeding time was prolonged to over 15 minutes.
8. Patients were treated with prednisolone, 6-mercaptopurine, vincristine, and cyclophosphamide without benefit. Four died of C.V.A. out of 6 cases whose deaths were confirmed. The mean duration from the onset of the initial symptoms to death was 52 days, and from admission to death 7 days.