前体B细胞淋巴母细胞淋巴瘤/白血病美罗华联合化疗治疗后复发伴CD_(20)抗原表达丢失1例报道并文献复习  

Lossing of CD_(20) antigen expression and relapsing after rituximab treatment in precursor B- cell lymphoblastic lymphoma/leukemia:a case report and review of the literature

作　　者：邹德慧[1] 赵耀中[1] 李睿[1] 林华[1] 刘欣[1] 钱林生[1] 邱录贵[1] 

机构地区：[1]中国医学科学院中国协和医科大学血液学研究所血液病医院,天津300020

出　　处：《白血病．淋巴瘤》2005年第4期208-211,共4页Journal of Leukemia & Lymphoma

摘　　要：目的探讨B细胞恶性肿瘤美罗华(rituximab)治疗后复发伴CD20抗原表达丢失患者的生物学特性。方法报道1例前体B细胞淋巴母细胞淋巴瘤/白血病(precursor-B-LBL/ALL)患者美罗华联合化疗治疗后复发时CD20抗原表达丧失,并进行文献复习。结果1例39岁男性前体B细胞淋巴母细胞淋巴瘤/白血病(pre-B-LBL/ALL)患者,初治时流式细胞(FCAS)检测瘤细胞表达CD19,CD20,CD22和CD25,弱表达CD34,而CD10表达阴性;免疫组化染色CD20广泛阳性;核型为92,XXYY,der(15)t(1;15)(q11;q26)×2[15]/46,XY[5]。经美罗华联合mBACOD诱导治疗2疗程后获得完全缓解(CR)。巩固化疗4疗程后,予美罗华、大剂量环磷酰胺(CTX)联合重组人源化粒细胞集落刺激因子(rh-G-CSF)动员、采集及冷冻保存自体外周血干细胞(PBSCs)。最后一疗程化疗4个月后患者复发,复发时流式细胞(FCAS)检测表达CD19,CD10,CD22,CD38和CD13,高表达CD34,而CD20,CD23和FMC7均阴性,免疫组化染色偶见CD20阳性细胞;核型转变为46,XY。结论B细胞恶性肿瘤美罗华治疗后复发患者应重新进行病理组织学、免疫表型和细胞/分子遗传学检测。Objective To study the biological feature（s） of B-cell neoplasm（s） relapsing and lossing of CD20 antigen expression after rituximab therapy. Methods To repot a case of lossing of CD20 expression and relapsing after rituximab plus chemotherapy treatment in pre B-cell lymphoblastic lymphoma/leukemia （pre-B LBL/ALL） and review of the literature. Results A 39-year-old man diagnosed with CD20postive pre B-cell lymphoblastic lymphoma/leukemia（pre-B LBL/ALL）.After rituximab plus mBACOD chemotherapy for two courses,the patient achieved a complete remission,and then consolidated for four courses. For mobilizing and collecting peripheral blood stem cells （PBSCs）, he received rituximab combined high-dose cyclophosphamide chemotherapy.Four months from the last cycle, the patient relapsed. Flow cytometry and immunochemistry, on the bone marrow revealed malignant B cell was CD20 negative common Bcell acute lymphoblastic leukemia（ALL）. The features of pathology, immunophenotype and karyotype had transformed at relapse. Conclusion It is necessary to perform new biopsies, immunophenotyping and genetics examination in replase of B-cell neoplasm（s） after rituximab treatment.

关 键 词：美罗华 B细胞恶性肿瘤 CD30表达丧失 

分 类 号：R733[医药卫生—肿瘤]