西达本胺、地西他滨联合CHAG方案治疗急性混合表型白血病1例并文献复习

One case of acute mixed phenotype leukemia treated with citabemine and descitabine combined with CHAG and literature review

目的:探讨混合表型白血病的有效诊断及诊治现状。方法:对1例混合表型白血病患者的诊治过程及方法作回顾性分析。结果:本例患者临床表现为咳嗽、全身乏力。骨髓穿刺及相关免疫学检查后确诊为急性髓系白血病(AML)伴T系表达,第一次给予IOAP方案诱导化疗(善维达20 mg qd d_(1~3)、西艾克4 mg d_(1)、阿糖胞苷100 mg q12 h d_(1~5)、地塞米松10 mg qd d_(1~5))后复查原发病未缓解,后给予西达本胺、地西他滨联合CHAG方案诱导化疗(西达苯胺30 mg biw、地西他滨25 mg d_(1~3)、高三尖杉酯碱2 mg d_(1~7)、阿糖胞苷50 mg q12 h d_(1~7)、阿克拉霉素20 mg d_(1)、d_(3)、d_(5)、d_(7))2阶段复查均达CR,患者一般情况较好,无其他特殊不适。结论:通过对本例的分析,混合表型白血病患者的诊断需要结合形态学和免疫学进行综合研究,尚缺乏高效治疗方案,建议对于混合表型白血病(T/髓系)患者采用兼顾T系与髓系的化疗方案。

Objective:To explore the effective diagnosis and treatment of mixed phenotype of leukemia.Methods:1 case of mixed phenotypic process and method of diagnosis and treatment of leukemia patients were retrospectively analyzed.Results:The patient showed cough,fatigue.Bone marrow biopsy and its related immunological test confirmed the diagnosis of acute myeloid leukemia(AML)with T line expressed.After the first administration of IOAP regimen induction chenotherapy(sunveda 20 mg qd d_(1~3),siac 4 mg d_(1),cytarabine 100 mg q12 h d_(1~5),dexamethasone 10 mg qd d_(1~5))the original disease did not resolve,and the subsequent two-stage induction chemotherapy of citabemine and descitabine combined with CHAG(citabemine 30 mg biw,descitabine 25 mg d_(1~3),homoharringtonine 2 mg d_(1~7),cytarabine 50 mg q12 h d_(1~7),aclarithromycin 20 mg d_(1),d_(3),d_(5),d_(7))achieved CR.The patients general condition was better,no other special discomfort.Conclusion:Through the analysis of this example,mixed phenotype diagnosis of leukemia patients need a comprehensive research combined with morphology and immunology,and there is no effective treatment.For(MPAL T/myeloid)patients both T system and myeloid chemotherapy regimens showed be taken.