急性白血病起始的慢粒急变4例报道并文献复习

A Report of 4 Cases of Acute Leukemia with CML-BC and Relevant Literature Review

目的探讨急性白血病起病的慢性粒细胞白血病急变期患者的临床特点及治疗方法。方法对4例以急性白血病起始的慢性粒细胞白血病急变期患者的诊疗过程进行报道,结合相关文献分析以急性白血病起始的慢性粒细胞白血病急变期患者的临床特点和治疗方法。结果4例患者均符合以急性白血病起始的慢性粒细胞白血病急变期,其中2例患者采用化疗及靶向治疗将患者的病情转变为慢性期,再进行异基因外周血干细胞移植,2例患者至今存活,生存期至少4年;1例予以甲磺酸伊马替尼治疗后转为慢性期,未行异基因造血干细胞移植,再次急变后死亡,生存期约100天;另1例诊断后仅接受羟基脲治疗,生存期1年。结论急性白血病起始的慢性粒细胞白血病急变期患者临床上较为罕见,使用化疗或靶向药物治疗使骨髓象得到缓解后再进行异基因造血干细胞移植,有望延长此类患者的生存期。

Objective To investigate the clinical characteristics and treatment of patients with chronic myelogenous leukemia in blast crisis(CML-BC).Methods A total of 4 cases of CML-BC were reported in the current study.The clinical characteristics and treatment methods of patient were analyzed based on the previous literature.Results All 4 patients showed the onset of acute leukemia.Two of them were treated by chemotherapy and target therapy and turned to the slow phase.Allogeneic peripheral blood stem cell transplantation was performed on these two patients and they have achieved more than 4 years of survival.One patient was treated with imatinib mesylate and turned into the slow phase but without undergoing allogeneic hematopoietic stem cell transplantation.This patient turned to blast crisis and passed away.The overall survival of this patient was about 100 days.The fourth patient underwent the treatment of hydroxyurea and survived for 1 year.Conclusion The onset of acute leukemia is rare in patients with CML.Using allogeneic hematopoietic stem cell transplantation after remission with chemotherapy or targeted therapy is expected to prolong the survival of patient.