急性单核细胞白血病M5转为急性红白血病M6一例病例分析及文献复习

A Case Report: Acute Monocytic Leukemia Switching to Acute Erythroid Leukemia and Review of the Literature

目的:红白血病为临床少见的急性髓系白血病亚型,白血病克隆转换不常见,在国内外文献中有关报道少见。通过对一例由急性单核细胞白血病转化的急性红白血病(acute erythroid leukemias,AEL)的病例分析,学习并探讨急性红白血病的临床特点及实验室检查特征,提高对急性红白血病疾病特点及白血病克隆转化的认识。方法:报道一例初诊为急性单核细胞白血病,后转为急性红白血病的患者。期间对其进行持续的细胞形态学,遗传学及分子生物学监测。结果:患者首次入院诊断为急性单核细胞白血病,经过一个疗程化疗后,骨穿显示从急性单核细胞白血病转为急性红白血病。随后再进行了一个疗程化疗,化疗结束后患者好转出院。后因经济原因,患者未继续治疗,2月后随访,患者死亡。结论:本例急性单核细胞性白血病化疗后转为红白血病。究其机制,可能有:一.发病是粒-单定向祖细胞和红系定向祖细胞同时受损,只是早期单核细胞系异常表现明显,红系异常早期表现不明显。或疾病起源于更早期造血干细胞,导致单核系和红系均有异常。二.在疾病过程中,骨髓微环境的变化,诱导红系异常而导致红白血病的发生。经过分析,本病例中,疾病可能起源于更早期造血干细胞的可能性较大,而骨髓微环境在疾病变化过程中则起到了重要的作用。这一结果有待进一步临床观察研究和肯定。提醒临床医生,提高动态的诊断和治疗意识,将有助于该疾病的预防、诊断和治疗。

Objective： Acute erythroid leukemia is rare.Clone switch in acute leukemia at relapse is an uncommom event, and therefore rarely reported in the literature. To improve the recognition of acute erythroid leukemia and mechanism of clone switch, here we report a case of acute monocytic leukemia switching to acute erythroid leukemia at relapse. Methods： To analyse a case of clone switch from acute monocytic leukemia to acute erythroid leukemia and get information at morphologic, cytogenetic and molecular levels during the treatment by some tests. Results： At initial diagnosis, the patient was acute monocytic leukemia. And switched to acute erythroid leukemia by analysis of results at morphologic, cytogenetic and molecular level after a cycle of chemotherapy. After another cycle of chemotherapy, the patient got a remission at morphologic level, and discharged. Afterwards,the patient gave up the treatment and died after 2 months. Conclusions： There would be two reasons to explain the clone switch： Firstly, the disorders come from the progenitor of red cells and monocytes, then cause the disease. As well, the disorders may come from impaired early hemapoietic stem cell（hsc）, leading to the monocytic and erythropoietic abnormalities. Secondly, the changes of bone marrow microenvironment induced erythroid abnormalities which lead to acute erythroid leukemia. In this case, the disease may have abnormalities in early hematopoietic stem cells, and the bone marrow microenvironment played an important role in the process of the disease. The results need to affirmed by further clinical observation and further researches. It remind us that dynamic diagnosis and consciousness of treatment need to improved, Which will contribute to the prevention, diagnosis and treatment of acute leukemia.