伴MLL-AF9基因重排和肝功能损伤的急性髓系白血病自发缓解一例报告并文献复习  

A case of spontaneous remission of acute myeloid leukemia with MLL-AF9 rearrangement and abnormal liver function

作　　者：樊文娟[1] 徐婷婷 桑丽娜[1] 郭洁洁 李亚飞[1] 裴智信 姜中兴[1] Fan Wenjuan;Xu Tingting;Sang Lina;Guo Jiejie;Li Yafei;Pei Zhixin;Jiang Zhongxing(Department of Hematology,The First Affiliated Hospital of Zhengzhou University,Zhengzhou 450000,China;Department of Blood Transfusion,Henan Provincial People's Hospital,Zhengzhou 450000,China;Jiaozuo First People's Hospital,Jiaozuo 454002,China)

机构地区：[1]郑州大学第一附属医院血液科,450000 [2]河南省人民医院输血科,郑州50000 [3]焦作市第一人民医院,454002

出　　处：《中华血液学杂志》2021年第10期851-857,共7页Chinese Journal of Hematology

摘　　要：目的探讨急性髓系白血病(AML)自发缓解的临床特点及可能的机制。方法回顾性分析郑州大学第一附属医院诊治的1例伴有MLL-AF9基因重排和肝功能损伤的AML自发缓解患者的临床资料,并进行相关文献报道病例汇总分析。结果该患者伴有MLL-AF9基因重排,经历了肺部感染、发热、肝功能损伤,治疗上给予抗感染、输注血制品,未经化疗,患者获完全缓解(CR),随访35个月,仍处于CR,期间伴有轻度间接胆红素升高。1990年至2021年6月文献报道的有骨髓检测支持的AML(非急性早幼粒细胞白血病)自发缓解患者56例,与本次报道的1例汇总分析,共57例患者,其中男37例,女20例,中位年龄51(20~83)岁,中位缓解时间为5个月,52例患者获得CR,5例具有染色体核型资料的长期缓解且至今未复发的病例,3例为正常染色体核型,2例伴有t(9;11)(q21;q23)异常。结论AML自发缓解罕见,可能与免疫抑制、基因均有关。Objective To explore the clinical features and possible pathogenesis of spontaneous remission of acute myeloid leukemia(AML).Methods We retrospectively analyzed the clinical data of a patient with spontaneous remission of AML,MLL-AF9 rearrangement,and abnormal liver function in the First Affiliated Hospital of Zhengzhou University,and the relevant pieces of literature were summarized.Results The patient experienced lung infection,fever,and liver dysfunction and was treated with antiinfection and blood transfusion.After complete response(CR),the patient remained in CR with mild,indirect bilirubin elevation at 35 months of follow-up.Additionally,56 cases of adult AML(non-acute promyelocytic leukemia)were reported in the literature from 1990 to June 2021.The cases were checked by bone marrow aspiration,and our patients were summarized and analyzed.Furthermore,57 patients,including 37 males and 20 females,with a median age of 51(20-83)years and a median remission time of five months;52 patients achieved complete remission.In addition,there were five cases with long-term remission and a chromosomal record,with no recurrence so far,three with normal karyotype and two with t(9;11)(q21;q23).Conclusion The spontaneous remission of leukemia is rare and may be related to immunosuppression and genes.

关 键 词：急性髓系白血病 自发缓解 MLL-AF9基因重排 感染 

分 类 号：R733.71[医药卫生—肿瘤] R575[医药卫生—临床医学]