PDF(Pubmed)
Abstract：
Acute promyelocytic leukemia (APL) is a unique, highly curable subtype of acute myeloid leukemia, owing to the therapeutic advances of the last decades which led to high complete remission rates and excellent long-term survival. Nevertheless, it remains associated with high early mortality rates. Early death is the major cause of treatment failure in APL and is mainly attributed to coagulopathy, differentiation syndrome, and less commonly, infectious events. Timely recognition of each complication plays a crucial role in the management of patients diagnosed with APL. Coronavirus Infectious Disease 2019 (COVID-19) has shown great heterogeneity in patient presentation. Clinical manifestations range from asymptomatic disease to severe forms, mainly characterized by a hyperinflammatory syndrome leading to acute respiratory distress and multiorgan failure. Patients with acute leukemia and concomitant COVID-19-related hyperinflammatory syndrome have particularly poor outcomes. We hereby report the case of a 28-year-old male patient who was diagnosed with high-risk APL, with severe associated coagulopathy at presentation. He was treated with chemotherapy according to the AIDA regimen. The first week of induction therapy was complicated by a differentiation syndrome manifesting as fever not attributable to infection and respiratory distress with pulmonary infiltrates, resolved after ATRA discontinuation and corticotherapy. On the fourth week of treatment, he tested positive for acute respiratory syndrome coronavirus 2 (SARS-CoV-2) with minor pulmonary involvement. Clinical manifestations over the following days included tachycardia and hypotension, associated with elevated inflammatory markers and cardiac biomarkers (troponin I x58 upper NV). Cardiovascular magnetic resonance imaging was consistent with myocarditis. COVID-19-associated myocarditis was successfully treated with methylprednisolone, intravenous immunoglobulins and Anakinra. Differentiation syndrome and COVID-19-associated myocarditis are two life-threatening complications that adversely impact survival. However, early recognition and prompt treatment initiation can improve clinical outcomes, as was the case of our patient.
摘要：
急性早幼粒细胞白血病(APL)是一种独特的,高度可治愈的急性髓系白血病亚型，由于过去几十年的治疗进展，导致高完全缓解率和优异的长期生存率。然而，它仍然与高早期死亡率有关。早期死亡是APL治疗失败的主要原因，主要归因于凝血病，分化综合征，不太常见，传染病事件。及时识别每种并发症在诊断为APL的患者的管理中起着至关重要的作用。2019年冠状病毒传染病（COVID-19）在患者表现出很大的异质性。临床表现从无症状疾病到严重疾病，主要以导致急性呼吸窘迫和多器官衰竭的过度炎症综合征为特征。急性白血病和COVID-19相关的高炎症综合征患者的预后特别差。我们特此报告一例28岁男性患者被诊断为高危APL,出现时伴有严重的相关性凝血病。他根据AIDA方案接受化疗。诱导治疗的第一周并发分化综合征，表现为非感染引起的发热和伴有肺浸润的呼吸窘迫，ATRA停药和皮质治疗后缓解。在治疗的第四周，他的急性呼吸道综合征冠状病毒2（SARS-CoV-2）检测呈阳性，肺部轻微受累。随后几天的临床表现包括心动过速和低血压，与升高的炎症标志物和心脏生物标志物（肌钙蛋白I×58上NV）相关。心血管磁共振成像与心肌炎一致。COVID-19相关性心肌炎用甲基强的松龙成功治疗，静脉注射免疫球蛋白和Anakinra。分化综合征和COVID-19相关心肌炎是两种威胁生命的并发症，对生存率产生不利影响。然而,早期识别和及时开始治疗可以改善临床结果，我们的病人也是如此.
