慢性淋巴细胞白血病203例相关并发症研究

Analysis on complications of 203 chronic lymphocytic leukaemia patients

目的探讨慢性淋巴细胞白血病（CLL）患者并发症的临床特点。方法回顾性分析就诊于中国医学科学院血液病医院并获得有效随访的203例CLL患者并发症的临床表现及其预后价值。结果40例（19．7％）患者发生部位明确的感染，最常见感染部位为肺部（75．6％）。15例（7．4％）患者发生自身免疫性疾病（AID），最常见的AID为自身免疫性溶血性贫血（AIHA）（31．3％）。8例（3．94％）患者并发第二肿瘤，包括肺癌等多种肿瘤。3例（1．48％）患者发生类型转化，其中，2例向幼淋巴细胞白血病（PLL）转化，1例向弥漫大B细胞淋巴瘤（DLBCL）转化（Richter综合征）。预后分析显示并发感染、第二肿瘤或转化与不良预后有关，并发AID与预后无明显相关。结论CLL患者常见并发症包括感染、AID、第二肿瘤或转化，其中，以肺部感染及AIHA最为常见，未见明显高发的第二肿瘤类型。并发感染、并发第二肿瘤或转化为不良预后因素。

Objective To summarize the common complications of chronic lymphocytic leukemia （CLL）. Methods 203 cases of CLL patients from the Institute of Hematology and Blood Diseases Hospital, CAMS ＆ PUMC, were retrospectively reviewed and followed up.The common complications of CLL were also summarized. Survival analysis was used to analyze the prognostic value of these common complications. Results 40 （19.7 %） patients sustained infectious complications,and the respiratory tract infections were the most common type （75.6 %）. 15 （7.4 %） patients complicated with autoimmune diseases （AID）, and the autoimmune hemolytic anemia（AIHA） were the most common type（31.3%）. 8（3.94 %） patients suffered from secondary cancers, including lung cancer, etc.3（1.48 %） patients developed other high-grade lymphomas, 2 of them transformed to prolymphocytie leukemia （PLL）, 1 of them transformed to diffuse large B cell lymphoma （DLBCL） which was called Richter syndrome. Complicating infections and secondary cancers or transformations were associated with poor prognosis.Complicating AIDs was not an adverse prognostic factor. Conclusion Infections, AIDs and secondary cancers or transformations are common complications of CLL patients.Lung is the most common infectious site, and AIHA is the most common AID type,none secondary cancer＇ s incidence rate is specifically higher than the others. Infections and secondary cancers or transformations indicate poor prognosis.