慢性淋巴细胞白血病合并多发性骨髓瘤一例并文献复习

Chronic lymphocytic leukemia complicated with multiple myeloma:report of one case and review of literature

目的 探讨慢性淋巴细胞白血病合并多发性骨髓瘤患者的临床特点、诊断、两种疾病发生顺序及克隆起源。方法 回顾性分析2018年5月吉林大学第一医院收治的1例慢性淋巴细胞白血病合并多发性骨髓瘤患者的诊疗经过,并复习相关文献。结果 该例患者以腰骶部疼痛起病,完善骨髓穿刺、流式细胞术检查、血液及尿液免疫固定电泳后诊断为慢性淋巴细胞白血病合并多发性骨髓瘤,建议Rd方案(来那度胺+地塞米松)或者MPV方案(美法仑+泼尼松+硼替佐米)治疗,但患者未行化疗,1个月后死于感染性腹泻。结论 多发性骨髓瘤和慢性淋巴细胞白血病的发生可以是同一克隆起源,也可以是不同的新克隆,二者同时发生非常罕见,治疗上倾向于更具侵袭性的多发性骨髓瘤为主的方案。

Objective To investigate the clinical features,diagnosis,occurrence sequence and clonal origin of chronic lymphocytic leukemia complicated with multiple myeloma.Methods The diagnosis and treatment of one patient with multiple myeloma and chronic lymphocytic leukemia who was admitted to the First Hospital of Jilin University in May 2018 was retrospectively analyzed,and the related literatures were reviewed.Results This patient began with lumbosacral pain,and he was diagnosed as chronic lymphocytic leukemia complicated with multiple myeloma after bone marrow aspiration,flow cytometry,and blood and urine immunofixation electrophoresis.It is recommended that Rd(lenalidomide+dexamethasone)or MPV(melphalan+prednisone+bortezomib)regimen,but the patient did not receive chemotherapy and died of infectious diarrhea 1 month later.Conclusions The occurrence of multiple myeloma and chronic lymphoblastic leukemia may originate from the same clone or different new clone.It is very rare that multiple myeloma and chronic lymphoblastic leukemia can co-occur.Therapeutic options tend to be more aggressive multiple myeloma-based regimen.