前期表现为再生障碍性贫血的成人急性淋巴细胞白血病一例并文献复习

Treating 1 case of acute lymphoblastic leukemia in adults with aplastic anemia in early stage and literature review

目的:探讨前期表现为再生障碍性贫血(AA)的成人急性淋巴细胞白血病(ALL)的临床特征。方法:报告1例前期表现为AA的成人ALL患者临床资料,并结合文献进行复习。结果:对12例(本例及文献11例)患者分析发现,男8例,女4例;9例患者以发热起病;9例1个月内血象恢复正常;9例于6个月内发展为ALL;再生障碍期9例行骨髓活检,均显示增生低下,其中7例伴有骨髓纤维化;白血病期6例进行免疫表型检测,其中B细胞型为4例;11例患者予化疗,仅有3例取得完全缓解(CR),部分患者于确诊ALL后短期内死亡。结论:前期表现为AA的成人ALL以男性多见;起病初多有发热;血象多于1个月内恢复,6个月内进展为ALL;再生障碍期行骨髓活检多提示增生低下伴骨髓纤维化;患者对化疗不敏感,CR率低,预后差。

Objective:To explore the clinical characteristics of ALL in adults with AA.Methods:A case of ALL in adults firstmanifested AA was reported;and the literature was reviewed.Results:In12patients,8cases were male and4cases were female;9patientswere diagnosed with fever;9patients were returned to normal blood counts in1mouth.9cases were occurred to ALL during6months.9cases in aplastic period showed low proliferation;and7cases were associated with myelofibrosis.In6cases of leukemia phase,4caseswere B-cell type.11cases were treated by chemotherapy,and3cases were CR;a part of patients died in a short period after the diagnosiswith ALL.Conclusion:ALL in adults with AA were more male,and shows fever in the early stage;than blood counts were recoveriesduring1month,and occurred to ALL during6months.Bone marrow biopsy in aplastic period shows hyperplasia with bone marrowfibrosis,with lower susceptibility to chemotherapy,lower CR rate and poor prognosis.