苯所致慢性髓性白血病5例临床分析  

Clinical analysis of 5 cases with chronic myelogenous leukemia caused by benzene

作　　者：詹昱[1] 杨志前[1] 曲佳[1] 冯可欣[1] 杨郁青[1] 谭明珠[1] 刘移民[1] ZHAN Yu;YANG Zhiqian;QU Jia;FENG Kexin;YANG Yuqin;TAN Mingzhu;LIU Yimin(The 12th People’s Hospital of Guangzhou/Guangzhou Occupational Disease Prevention and Treatment Hospital,Guangzhou,Guangdong 510620,China)

机构地区：[1]广州市第十二人民医院(广州市职业病防治院),广东广州510620

出　　处：《职业卫生与应急救援》2021年第3期296-299,355,共5页Occupational Health and Emergency Rescue

基　　金：广州市高水平临床重点专科建设项目(穗卫函[2019]1555号)。

摘　　要：目的提高对苯所致慢性髓性白血病(chronic myelogenous leukemia,CML)的认识,加强预防,规范治疗。方法回顾性分析2009—2020年5例苯所致CML患者的苯接触史、临床特征、诊治过程及转归情况。结果 5例患者发病年龄28~41岁,中位数35岁;苯接触时间4~10年,中位数6年;潜伏时间4~10年,中位数6年。工作中均无个人防护。起病以乏力为主,ECOG评分为0~1分,轻度脾大4例。外周血白细胞升高明显,血小板正常。均诊断为CML慢性期。患者Sokal评分均为低危组。均口服靶向药物酪氨酸激酶抑制剂(tymsine kinase inhibitor,TKI),从诊断CML到起始TKI治疗时间1~29个月,中位数11个月。口服TKI累计6~10年,中位数8年。3个月时全部患者获完全血液学反应(complete hematological response,CHR),其中3例获早期分子学反应(early molecular response,EMR),6个月时全部获完全细胞遗传学反应(complete cytogenetic response,CCyR),12个月时全部获主要分子学反应(major molecular response,MMR)。但经长期用药和随访,仅1例获得深度分子学反应,未获深度分子学反应的患者无法实现停药后无治疗缓解。结论苯所致白血病类型多样,但CML少见。一旦明确诊断,应尽早应用TKI规范治疗,长期严格随访。Objective This study was purposed to raise awareness of chronic myelogenous leukemia(CML)caused by benzene,so as to strengthen prevention and standard treatment. Methods A retrospective analysis was made on the history of benzene exposure,clinical characteristics,diagnosis and treatment process and outcome of 5 patients with CML caused by benzene from 2009 to 2020. Results The median age of onset of 5 patients was 35(28-41)years old,the median benzene exposure time was 6(4-10)years,and the median latency time was 6(4-10)years. There were no strict personal protections at work. The main clinical manifestation was fatigue,and the ECOG scores were 0-1. Mild splenomegaly occurred in 4 cases. The peripheral blood was obvious high in leukocytes and normal in platelets. All patients were diagnosed as CML in chronic phase and classified as low-risk groups by Sokal score. These patients all took the tymsine kinase inhibitor(TKI). The median time from diagnosis to the initiation of TKI treatment was 11(1-29) months,and the median time of total TKI treatment time was 8(6-10)years. Complete hematological response(CHR)was achieved in all patients at 3 months,including 3 cases with early molecular response(EMR),complete cytogenetic response(CCyR)at 6 months,and major molecular response(MMR)at 12 months. However,during the long-term medication and follow-up,only one patient achieved deep molecular response,and the patients who did not get deep molecular response failed to meet the withdrawal criteria and could not achieve treatment free remission after withdrawal. Conclusions There are various types of leukemia caused by benzene,but CML is rare. Once the diagnosis is confirmed,treatment should be standardized as soon as possible,including early application of TKI,and long-term strict follow-up is necessary.

关 键 词：苯 慢性髓性白血病 职业性 酪氨酸激酶抑制剂 CML TKI 

分 类 号：R135.12[医药卫生—劳动卫生]