妊娠合并急性白血病的临床分析

Clinical analysis of pregnancy combined with acute leukemia

目的探讨妊娠合并急性白血病的临床特点,以期提高临床对该病的诊治水平及近期疗效。方法选择2009年1月至2014年1月广东省惠州市中心人民医院和北京军区总医院收治的10例妊娠合并急性白血病患者的临床病历资料为研究对象,进行回顾性分析。本组患者的中位年龄为29.5岁（20~36岁）,平均孕龄为15.4孕周（6~31孕周）。其原发病中,9例为急性髓系白血病（AML）,1例为急性淋巴细胞白血病（ALL）。对本组10例妊娠合并急性白血病患者采用Kaplan-Meier方法进行生存期分析。本研究遵循的程序符合惠州市中心人民医院和北京军区总医院人体试验委员会所制定的伦理学标准,得到该委员会批准,征得受试对象本人的知情同意,并与之签署临床研究知情同意书。结果本组6例早孕期患者的妊娠结局中,4例为自然流产,2例采用药物终止妊娠;2例中孕期患者的妊娠结局中,1例为引产,1例引产失败后最终自然分娩;其余2例晚孕期患者的妊娠结局为自然分娩。本组3例妊娠合并急性白血病患者自然分娩的新生儿均健康。对本组10例妊娠合并急性白血病患者采取诱导化疗治疗措施后,5例取得完全缓解（CR）,5例复发或转为难治性白血病。对本组10例患者随访至2014年10月,其中位生存期为19.2个月（5~50个月）,1,2及3年总生存率分别为8/10,2/10及1/10。结论妊娠合并急性白血病患者长期预后差,属于高危型白血病。对于早孕期该病患者,应及时终止妊娠,并积极化疗;对于中、晚孕期患者,则应尽量化疗取得CR,以改善母儿预后。

Objective To study the clinical character and short-term effect of pregnancy combined with acute leukemia,in order to improve the level of diagnosis and treatment of this disease.Methods Retrospective analysis of 10 cases of pregnant women with acute leukemia in Huizhou Municipal Central Hospital,Guangdong Province and the Military General Hospital of Beijing PLA from January 2009 to January 2014.The median age of all patients was 29.5 years（20-36 years）,and the mean gestational age was 15.4 weeks（6-31 weeks）.Among them,9 cases were with acute myeloid leukemia（AML）,and 1 case of acute lymphocytic leukemia（ALL）.The study protocol was approved by the Ethical Review Board of Investigation in Human Being of Huizhou Central People′s Hospital,Guangdong Province and General Hospital of Beijing Military Area Command of Chinese PLA.Informed consent was obtained from all participants.Results Among 10 cases of pregnant women with acute leukemia,6 cases were early pregnancy,including 4 cases of spontaneous abortion,and 2 cases of drug abortion;2 cases were middle pregnancy,including 1 case of abortion,and 1 case failed induction of labor and natural childbirth finally;the other 2 cases of late pregnancy accepted natural childbirth.3 cases of delivery infants by pregnant women with acure leukemia all were health.There were 5 cases achieved complete remission（CR）and 5 cases relapsed leukemia.As follow up to October 2014 after induction chemotherapy,the median survival time of all patients was 19.2 months（5-50months）.1-,2-,3-year overall survival rates of these 10 cases of pregnant women with acute leukemia were 8/10,2/10 and 1/10,respectively.Conclusions The long-term prognosis of pregnancy combined with acute leukemia is poor and it belongs to the high-risk types of leukemia.For patients with early pregnancy of this disease,abortion and active chemotherapy should be carried out,but for patients with middle and late pregnancy,chemotherapy should be tried to carried out and achieve CR to improve the prognosis of mothers and infants.