衰竭期骨髓转移癌临床表现及其治疗对策

Clinical Characteristics of Patients with Metastatic Carcinoma in Bone Marrow in Exhaustion Phase and the Value of Emergency Chemotherapy Combined with Best Supportive Care as a Treatment Strategy

目的:探讨衰竭期骨髓转移癌(MCBM)的发病率、病史、临床表现、诊断要点和治疗方法。方法:对疑似病例行骨髓穿刺和(或)活检、PET-CT检查,病理学确诊者中9例行抢救性化疗联合最佳支持治疗(BSC),另6例仅给予BSC,收集患者症状、体征、病史、体质状态评分(KPS评分)、血常规、骨髓特点、合并症、缓解率、生存期等数据。结果:2876例患者中发现该病15例,临床表现为进行性加重的乏力,病史多不足3个月,部分患者有实体瘤病史而另一部分患者疑似血液系统疾患而就诊,骨髓均增生低下有时可发现有分类不明的细胞或较为典型的转移瘤细胞,并有贫血,KPS评分不足50分,14例伴血小板减少症,3例合并弥散性血管内凝血(DIC)。其中9例接受了抢救性化疗及BSC,临床受益率88.9%(8/9),生存期20天至5年7个月;而仅接受BSC者生存期仅为20天至3个月。结论:衰竭期骨髓转移癌临床罕见,起病隐匿,病史多不足3个月,临床表现为不明原因并进行性加重的贫血和血小板减少症,诊断亦较为困难,骨髓检查常显示骨髓增生低下有时可发现有分类不明的细胞或较为典型的转移瘤细胞,该病的治疗国内外尚无成功的经验和方法,减量的抢救性化疗联合BSC可能有效,生存期明显延长,打破了该期患者不宜化疗的传统观念。

Objective： To study the incidence of metastatic carcinoma in bone marrow （MCBM） in the exhaustion phase and its clinical characteristics, and to explore the value of emergency chemotherapy combined with best supportive care （BSC）. Methods： Patients with suspected MCBM in the exhaustion phase were examined by bone marrow puncture and/or biopsy together with PET-CT scans. Nine patients with MCBM received emergency chemotherapy and BSC and the other 6 patients only received BSC. Clinical outcomes, significant history, bone marrow, outcome of routine blood examination, Karnofsky Score （KPS score）, complications, remission rate and patient survival were analyzed after treatment. Results： Among 2,876 patients, 15 cases were found with MCBM in the exhaustion phase. These 15 cases had anemia and a history of less than 3 months. They had bone marrow hypoplasia and KPS scores less than 50. Among them, 14 cases had thrombocytopenia and 3 cases had disseminated intravascular coagulation （DIC）. For the 9 patients treated with emergency chemotherapy and BSC, the clinical benefit rate was 88.9% （8/9） and the survival was 20 days to 5 years and 7 months. The other 6 patients treated with only BSC had a short survival time （20 days to 3 months）. Conclusion： MCBM in the exhaustion phase is rare and the onset is occult. Clinical manifestations are anemia, thrombocytopenia and bone marrow hy- poplasia with or without solid tumor history. The diagnosis is difficult. Emergency chemotherapy with reduced dosage in combination with BSC may be of benefit for patients with MCBM in the exhaustion phase and can increase patient survival.