1. Chief complaint and medical history.
Patient Wang XX, male, 49 years old, was admitted to the hospital with “diagnosis of acute myeloid leukemia M21.5 years and 11 months of relapse”.
The patient was found to be leukopenic on physical examination in February 2010, with WBC 1.6×109/L, hemoglobin and platelets were not abnormal. On August 3, 2011, the patient was admitted to 307 Hospital, with routine blood count: WB C73.77×109/L, Hb103g/L, Plasma Hb103g/L, Pl The bone marrow picture: extremely active hyperplasia, with 79% of primitive cells. 79%, immunohistochemistry: POX (100%); C E (19%); NSE (0%); Na F (0%), immunophenotype: cMPO: 56.1%. CD33: 98.8%; CD 64: 63.5%; CD11 7: 37%; CD38: 21.4 4 %, fusion gene: AML-ETO (+), diagnosis of A ML-M2, 2011 On August 10, 2011, he was given MA (MIT2 0mg d1-d3; A ra-C250mg d 1-d7) chemotherapy, PR, followed by IA+C TK cells (IDA20mg d1-4; Ara-C 200mg d1-7. On 09/29/2011, he was treated with IA+C TK cells (IDA 20mg d1-4; Ara-C 200mg d1-7. On November 14, 2011, we performed H D-Ara-C (2.5 g/m2, total 28g) + CTK cells on November 14, 2011. After stopping chemotherapy for 3 months, the bone marrow was reexamined: active proliferation, 44% of primitive and naive cells, ETO continued to be negative. The bone marrow was reexamined: active proliferation, 44% primitive and naive cells, ETO continued to be negative, and M AT + CTK cells (MIT 20mg d 1-d3; Ara-C 250mg d1-d7, VM26 150mg d2, d5) for re-induction chemotherapy, and donor frozen hematopoietic stem cells were returned on day 8. Bone marrow: primary cells: 21%, 2012-05 HAT was re-induced on 17 May 2012, and the donor’s frozen hematopoietic stem cells were transfused on day 9. On 012-06-21, bone aspiration was performed ( 307 Hospital): active proliferation, 17.5% of primitive + naive cells, blood count: WB C2.74×109/L, H b62g/L, Plt1 5×109/L, was admitted to hospital on June 25, 2012 due to fever.
2. Summary of the four examinations.
Look: the face is colorless, with a severe anemic appearance, the tongue is light with white and greasy coating, with teeth marks.
Smell: normal speech, no cough, no phlegm, no special smell.
Q: fever, T: 38.9°, sweating, weakness, coughing and phlegm, dizziness and headache, no nausea and vomiting, no abdominal pain and diarrhea, good diet and sleep.
Cut: sunken and weak pulse.
3.Laboratory examination
Routine blood tests: WBC2.74×109/ L, Hb62g/L, Pl t15×109／L.
2012-06-29 Bone aspiration return: hypoplasia; G: 47%, E: 46%, G: E = 1.02, granulomatous hyperplasia, primitive 9%, red hyperplasia, lymphatic 5%, no megakaryocytes seen in the whole film.
4. Disease diagnosis
1. Acute myeloid leukemia M2
Relapse after 3 courses of chemotherapy
Relapse after 2 courses of chemotherapy without remission
2. pneumonia (mixed fungal bacterial infection)
3. hypertension grade 2 (very high risk)
5. Treatment history
The patient felt epidemic and evil toxins, and when the evil comes together, his qi must be deficient; deficiency of qi and blood, which leads to weakness; deficiency of qi, which leads to loss of nourishment of the clear orifices, which leads to dizziness and headache; incandescence of evil heat, which leads to fever; pale tongue with white greasy coating and teeth marks, and sunken and weak pulse, all of which are signs of positive deficiency and evil. The disease belongs to the category of “acute leukemia” in Chinese medicine.
After admission, the patient was given anti-infective treatment with Tylenol + Stable + voriconazole + Kesex, blood transfusion support, 2 capsules of Qinghuang capsule twice a day to detoxify and dispel evil, and intermittent arsenious acid injection (Qinghuang capsule was suspended during this period). After more than 6 months of treatment, the patient’s blood picture increased, and the current blood routine: WBC 1.09×1 09 / L, Hb104g/ L, Plt85×109/ L. L. 2013-01-09 09 bone puncture return (Xiyuan Hospital): active hyperplasia, G: 62%, E: 32%. G:E = 1.94:1, granulomatous hyperplasia, primitive 8%, early juvenile 5%, red hyperplasia. Lymph: 5%, no meganuclei were seen in the whole film.
6. Treatment effect
PR, blood picture increased, the current blood routine: WBC1.09×109/L, Hb104 109/L, Hb104 g/L, Plt85×10-9/L. He was discharged from blood transfusion.
Experience]
Patient M2 relapse, after chemotherapy + microtransplantation, bone marrow original 9% at the time of admission, PR status, at that time the patient’s lung severe infection is not tolerant to chemotherapy, according to the condition of experts to be Qing Huang capsule + arsenious acid injection program, after After the treatment, the patient was discharged from blood transfusion and the blood picture increased significantly, although the bone marrow primitive cells did not decline, but the purpose of significantly improving the quality of life. Experts often use Qing Huang capsule to treat various hematological diseases, including MDS, AML which is intolerant to chemotherapy, and especially to treat M DS has achieved good results.
Qing Huang Capsules are composed of Qing Dai and Xiong Huang, which are salty and cold in nature and enter the liver meridian to eliminate swelling, disperse blood stasis, cool the blood and detoxify the toxin; Xiong Huang is pungent and warm in taste and can detoxify all kinds of toxins, eliminate accumulation and resolve blood stasis in the abdomen. The combination has the effect of dispelling evil and removing toxins, activating blood circulation and resolving blood stasis. The main component of Xiong Huang is arsenic sulfide, and modern research shows that arsenic has the effects of free radical oxidation killing and demethylation, in addition to targeting and inducing differentiation of tumor cells. This time, according to the characteristics of the patient’s internal evil toxicity, the use of arsenic detoxification to eliminate evil, in order to achieve the purpose of encouraging the righteousness, restore hematopoiesis, clinical results. The treatment of malignant hematological diseases with arsenic agent is worth further exploration.