对1例被误诊为骨髓增生异常综合征的老年急性淋巴细胞白血病患者的分析

Analysis of an elderly patient with acute lymphoblastic leukemia misdiagn osed as myelodysplastic syndrome

目的:对被误诊为骨髓增生异常综合征(myelo-dysplastic syndrome,MDS)的老年急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患者的临床和病理学特征、诊疗要点及预后等进行案例讨论。方法:观察1例因MDS样表现被误诊的老年ALL患者的临床诊疗过程及结果,并进行相关文献复习。结果:该例73岁男性患者因乏力伴食欲下降等临床症状而在某医院就诊,初步诊断其病情为MDS合并原始细胞过多,其经治疗后出院。4周后复查血常规示:白细胞计数2.0×10^(9)/L,红细胞计数2.9×10^(12)/L,血红蛋白86 g/L,血小板计数88×10^(9)/L,网织红细胞绝对值1%。随后转入丽水市人民医院就诊,经骨髓涂片检查被确诊患有Ph染色体阴性急性B淋巴细胞白血病(B-ALL)。采用VDLP方案进行1个疗程的诱导化疗后其疗效为完全缓解,后续采用CAM方案、减低剂量MA方案各进行1个疗程的化疗,治疗效果佳。随访期间,患者血常规指标均在正常范围(未接受骨髓涂片检查)。结论:老年ALL患者可因MDS样表现而被误诊。临床检查中发现疑似MDS患者存在原始细胞比例偏高、不明原因骨髓坏死时,需考虑其患有ALL的可能性。

Objective:The clinical and pathological features,diagnosis,treatment and prognosis of elderly patients with acute lymphoblastic leukemia(ALL)misdiagnosed as myelo-dysplastic syndrome(MDS)were discussed.Methods:To observe the clinical diagnosis and treatment process and results of 1 elderly ALL patient who was misdiagnosed due to MDS-like appearance,and review relevant literature.Results:The 73-year-old male patient was admitted to a hospital due to clinical symptoms such as fatigue and loss of appetite.His condition was preliminarily diagnosed as MDS complicated with excessive primitive cells,and he was discharged after treatment.Blood routine examination 4 weeks later showed:WBC count 2.0×10^(9)/L,RBC count 2.9×10^(12)/L,hemoglobin 86 g/L,platelet count 88×10^(9)/L,reticulocyte absolute value 1%.Later,he was admitted to Lishui People’s Hospital,where he was diagnosed with Ph chromosomal negative acute B-cell leukemia(B-ALL)by bone marrow smear examination.After 1 course of induction chemotherapy with VDLP regimen,the curative effect was complete remission,followed by 1 course of chemotherapy with CAM regimen and 1 course of reduced dose MA regimen,the therapeutic effect was good.During the follow-up period,the patients’blood routine indicators were within the normal range(no bone marrow smear examination was performed).Conclusion:Elderly patients with ALL may be misdiagnosed due to MDS-like appearance.When a high proportion of primitive cells and unknown bone marrow necrosis are found in suspected MDS patients in clinical examination,the possibility of ALL should be considered.