肝移植后的继发急性髓系白血病

Acute myeloid leukemia after liver transplantation

背景:肝移植后急性髓系白血病是一种极少见但病死率极高的并发症。目的:分析肝移植后急性髓系白血病的临床特征。方法:报告1例肝移植后发生急性早幼粒细胞性白血病病例,并辅以文献复习。结果与结论:患者接受原位肝移植后85个月,拔牙后出血不止,进一步查凝血功能异常、血常规、骨髓细胞学、白血病免疫分型检查提示为急性早幼粒细胞白血病、PML/RARa融合基因阳性,明确诊断急性早幼粒细胞性白血病,合并弥散性血管内凝血,给予输注新鲜冰冻血浆纠正凝血异常,经维甲酸、亚砷酸、柔红霉素联合诱导化疗,骨髓完全缓解。予柔红霉素和阿糖胞苷,米托蒽醌和阿糖胞苷巩固化疗2个疗程,之后定期予亚砷酸化疗,骨髓持续缓解。化疗同时,调整免疫抑制剂剂量和类型,患者肝功能稳定,未发生严重感染等并发症。结果说明,肝移植后可并发急性髓系白血病,以急性早幼粒细胞白血病常见,肝移植患者出现血象、凝血异常,要考虑急性早幼粒细胞白血病可能。应早期诊断及治疗,以减少死亡率。

BACKGROUND： Acute myeloid leukemia after liver transplantation is a rare complication with high mortality. OBJECTIVE： To study the clinical features of acute myeloid leukemia after liver transplantation. METHODS： One case of acute promyelocytic leukemia after liver transplantation was reported, and literatures were reviewed. RESULTS AND CONCLUSION： Case presentation was post-odontectomy bleeding with associative abnormal coagulation test at 85 months after liver transplantation. Routine blood test, bone marrow test and chromosome analysis and examination diagnosed as acute promyelocytic leukemia and promyelocytic leukemia/RARa positive chimeric gene, and clearly diagnosed as acute promyelocytic leukemia combined with disseminated intravascular coagulation. The patient received fresh frozen plasma transfusion to correct the abnormal coagulation, and then received induction chemotherapy with retinoic acid, arsenic trioxide and daunorubicin to obtain bone marrow complete remission. The patient was treated with daunorubicin combined with cytarabine and mitoxantrone combined with cytarabine regimens after remission induction to consolidate the chemotherapy for two courses of treatment, and then subsequently subjected to arsenous acid chemotherapy, and the bone marrow was sustained for remission. During chemotherapy, the dose. and type of immunosuppressive agents were adjusted, and the patient had stable liver function without serious infection or complications. The results indicate that acute myeloid leukemia is common and often occurs after liver transplantation. When the patient displays hematological abnormality, acute promyelocytic leukemia should be considered. Early diagnosis and treatment can reduce the mortality.