异基因外周血干细胞移植后的心膈角髓肉瘤  

Myeliod sarcoma in cardio-phrenic angle after allogeneic peripheral blood stem cell transplantation

作　　者：何易[1,2] 李旭东[1,2] 王东宁[1,2] 胡元[1,2] 王文文[1,2] 刘加军[1,2] 林东军[1,2] 黄仁魏[1,2] 

机构地区：[1]中山大学血液病研究所 [2]中山大学附属第三医院血液内科,广东省广州市510630

出　　处：《中国组织工程研究》2013年第27期5041-5047,共7页Chinese Journal of Tissue Engineering Research

摘　　要：背景: 异基因造血干细胞移植是治愈白血病的主要方法,但经过异基因造血干细胞移植的患者仍面临着复发的风险,髓肉瘤为一种罕见的髓外复发方式,且临床疗效差,因此了解髓肉瘤的特点及治疗方法十分必要。目的: 分析异基因外周血干细胞移植后髓肉瘤的临床特点及治疗方法。方法: 异基因外周血干细胞移植后并发心膈角髓肉瘤患者1例,先后予手术切除肿块、化疗、放疗等联合方法治疗,观察临床疗效及相关并发症和生存情况。结果与结论: 患者在2个疗程的化疗过程中出现了败血症、真菌性肺炎及感染性休克等并发症,之后接受了纵隔放疗,髓肉瘤未再复发。无病生存25个月后出现中枢神经系统白血病。造血干细胞移植后髓肉瘤罕见且临床表现多变,主要依靠病理组织学和免疫组化检查确诊。可采用手术、化疗、放疗、二次移植和分子靶向治疗等方法,但个体化的治疗方案仍需进一步探讨。OBJECTIVE： To analyze the clinical characteristics and treatment methods of myeliod sarcomas in cardio-phrenic angle after allogeneic peripheral blood stem cell transplantation. METHODS： One case was diagnosed as single myeloid sacoma in the cardio-phrenic angle after allogeneic peripheral blood stem cell transplantation. The patient underwent surgical resection of the mass, chemotherapy and radiotherapy. The clinical effect, complications and survival situation were observed. RESULTS AND CONCLUSION： The patient suffered from bacteremia, fungal pneumonia and even life-threatening sepsis shock during two courses chemotherapies. Then, the patient received radiotherapy for mediastinum and the myeloid sacoma never relapsed. However, the patient suffered central nervous system leukemia after free of the disease for 25 months. Myeliod sarcoma after allogeneic hematopoietic stem cell transplantation is rare and its manifestation is changeful. The diagnosis mainly depends on histopathology and immunohistochemistry. Surgery, chemotherapy, radiotherapy, second transplantation and molecular targeteddrugs are the choices of treatment strategy. However, the optimal treatment strategy for individual patients remains to be determined.

关 键 词：干细胞 干细胞移植 急性髓系白血病 异基因干细胞移植 髓肉瘤 心膈角 化疗 放疗 干细胞图片文章 

分 类 号：R394.2[医药卫生—医学遗传学]