慢性粒细胞性白血病并骨髓纤维化患者格列卫停药致骨髓坏死1例临床分析

Bone marrow necrosis in a chronic myelogeneous leukemia patient with myelofibrosis following withdrawl of Gleevec

目的:探究格列卫治疗相关毒副反应,总结相关毒副反应的临床表现、实验室特征。提高临床医生对于格列卫相关毒副反应的认识和处理水平。方法:分析1例接受格列卫治疗的慢性粒细胞白血病并骨髓纤维化患者自行停药后出现致死性骨髓坏死的临床表现特征,实验室检查,治疗过程及预后情况。结果:该例慢性粒细胞白血病并骨髓纤维化患者对羟基脲、干扰素和常规HA方案化疗不敏感。患者接受格列卫治疗1月后临床症状、血象明显改善。格列卫治疗2月后出现背痛,下肢疼痛副反应。格列卫不当停药后出现致死性骨髓坏死。结论:格列卫对于慢性粒细胞白血病合并骨髓纤维化患者的疗效尤其优于羟基脲、干扰素和常规化疗。接受格列卫治疗的患者当出现药物副反应考虑停药时应慎重。

Objective： To investigate the clinical characteristics, laboratory features and mechanism of Gleevec-related adverse events in patients with chronic myelogeneous leukemia. Methods： Clinical manifestations, laboratory examinations, imaging data, pathologic histology, procedure of treatment and prognosis were analyzed in a chronic myelogeneous leukemia patient with myelofirbosis who developed fatal bone marrow necrosis following discontinuation of Gleevec due to Gleevec-related pain in lower back and legs. Results： The Patient were insensitive to traditional therapeutic methods such as hydroxyurea, interferon and combinational chemotherapy of Ara-C and homoharringtonine. The leukocytosis and constitutional symptoms were rapidly reversed following treatment of Gleevec one month later. The pain in lower back and legs developed two months after initiation of Gleevec treatment. Life-threatening bone marrow necrosis occurred acutely with deterioration of pain, thrombocytopenia, splenomegaly and generalized bleeding, when patients discontinued the drug abruptly by himself. Conclusions： Gleevec demonstrated favorable therapeutic effect to the chronic myelogeneous leukemia patient with myelofibrosis who didn＇t respond to traditional treatments including hydroxyurea, interferon and combinational chemotherapy. It should be prudent for doctors to advice patients accepting Gleevec treatment with onset of side effects to terminate this drug suddenly.