多发性骨髓瘤继发急性粒单核细胞白血病1例报告

Acute Myelomonocytic Leukemia Occurred after Multiple Myeloma Treated:a Case Report

报道1例我院收治的多发性骨髓瘤患者治疗后继发急性髓系白血病（M4型）。患者有5年多的多发性骨髓瘤病史，经过长期包括马法兰和环磷酰胺在内的多药化疗，多项实验室检查（骨髓细胞形态学、血清蛋白电泳、血清免疫固定电泳、尿轻链检查）表明多发性骨髓瘤基本达到缓解。但患者出现不明原因的外周血全血细胞下降，在单独采用输血和血小板支持治疗的同时动态观察其血常规发现，外周血白细胞开始逐渐上升并出现原始细胞（8％～15％）。进一步行骨髓涂片检查其中原始细胞比例达30％以上，流式细胞术检测显示A、C群细胞在表达CD45同时表达人类白细胞抗原DR（HLA—DR）、CD13、CD33、CD64，诊断为：①多发性骨髓瘤缓解期；②继发性急性粒单核细胞白血病（AML—M4）。诊断明确后正拟行针对白血病的化疗,患者由于血小板计数太低、输注效果差，发生消化道大出血死亡。

We reported a case of multiple myeloma, who suffered from the acute myelomonocytic leukemia （AML-M4） after the chemotherapy of alkylating agent. The patient had a history of multiple myeloma and was treated with the regimen of including L-Sarcolysinum and cyclophosphamide for 5 years. The multiple myeloma of this patient was proved to have got the remission through bone marrow aspiration, immunofixation electrophoresis of serum, serum protein electrophoresis and detection of urine light chain. However, a pancytopenia of unknown cause was verified to peripheral blood. During the course of supportive treatment only with blood cell and platelet transfusion, WBC count of this patient showed a rising trend and the blast cells （8%-15%） started to occur in the peripheral blood. The further examination discovered that the ratio of blast cell was beyond 30% in bone marrow smear, and the flow cytometry detected the CD45,HLA-DR,CD13,CD33,CD64 to have the positive expressions. Thus, the diagnosis of multiple myeloma in remission and secondary AML-M4 was established. When the chemotherapy regimen to AML was being planned for this patient, she died of massive hemorrhage of gastrointestinal tract due to thrombocytopenia and ineffectiveness.