白血病相关性副癌综合征——白血病相关性关节炎

LEUKEMIA RELATED PARANEOPLASTIC SYNDROME-LEUKEMIA RELATED ARTHRITIS

目的:提高对白血病相关性副癌综合征的认识,减少临床漏诊、误诊。方法:通过2例病例并结合文献复习,对白血病相关性关节炎的发病机制、临床表现、诊断、治疗及预后进行讨论和分析。结果:2例急性淋巴细胞白血病均以关节炎、腰背痛为首发症状,分别于出现症状后4个月和2个月确诊,经VDCAP/VDLP方案诱导1疗程即达完全缓解,经大剂量甲氨蝶呤强化。1例用多种化疗方案循环维持治疗30个月,于第31个月复发;1例行异基因骨髓移植治疗至今30个月,仍处于CR1。结论:关节炎可为白血病的首发表现,并可出现于血象及骨髓象异常之前数月,临床上极易漏诊、误诊。发病机制尚不十分明确。治疗方法主要为抗白血病治疗。

Objective: To increase the identification of leukemia related paraneoplastic syndrome and reduce the misdiagnosis. Methods: Combined with literatures reviewed, to discuss and analyze the pathogenesis, clinical situation, diagnosis, treatment and prognosis of leukemia related arthritis and report two cases infected with leukemia related arthritis. Results: The primary symptoms of 2 patients infected with acute lymphocytic leukemia were arthritis and low back pain. Then the diagnosis was made 4 months and 2 months later respectively. The complete remission was achieved after one course of remission induction therapy of VDCAP/VDLP, and consolidated by means of high doses MTX. One patient accepted remission maintenance therapy of a variety of chemotherapy regime used circularly and had maintained CR for 30 months, at 31th month relapsed. The other accepted allogeneic bone marrow transplantation and maintained CR1 for 30 months till now. Conclusion: The arthritis can be the primary symptoms of leukemia, and several months later the abnormality of hemogram and bone marrow examination appear. Misdiagnosis can occur easily. The pathogenesis of leukemia related arthritis is not very clear. The major treatment for leukemia related arthritis is anti-leukemia treatment.