治疗相关白血病1例报告

A case report of therapy related MDS/AML and literature review

目的探讨急性淋巴细胞白血病患者长期化疗后发生治疗相关骨髓增生异常综合征白血病(t-MDS/AML)的临床特征及预后。方法观察一例儿童急性淋巴细胞白血病经化疗后演变为幼年慢性粒-单核细胞白血病(JMML)的临床演变过程及治疗结果并进行相关文献复习。结果1例急性淋巴细胞白血病患儿经3年正规化疗停药后3月,外周血白细胞进行性增高并出现原始粒、单核细胞。各项检查支持幼年慢性粒-单核细胞白血病诊断。根据2000年WHO造血组织和淋巴组织肿瘤分类方法,归于MDS/MPD一类疾病。患者迅速进展为AML-M4b,治疗无效死亡。结论t-MDS比原发性MDS病情进展更快,预后更差。t-AML临床预后不良,骨髓移植及大剂量化疗仅对部分患者有效。应进一步加强儿童ALL患者的合理用药,根据不同危险度分型,选取相应治疗强度化疗方案,以减少t-MDS/AML发生的可能。

Objective To explore the characteristics and outcome of children with t-MDS/AML Methods We reported an acute lymphoid leukemia patient evolved t-MDS （JMML） after chemotherapy and we also review the related literatures. Results After three years of chemotherapy, the patient evolved to a subtype of MPD/MDS, JMML. She evolved to AML-M4b within 3 months after diagnosed as t-MDS. Conclusion t-MDS are more aggressive and have worse outcome than de novo MDS. BMT and chemotherapy can benefit for a minor part of patients, pediatric patients of ALL should stratify as higher-or lower-risk groups and treat in dlifferent intensity.