急性早幼粒细胞白血病非正规治疗9年后完全缓解继发慢性粒细胞白血病一例  

A study on the complete remission and secondary chronic myelogenous leukemia after 9 years’ informal treatment of acute promyelocytic leukemia:a case report

作　　者：黄卉 郑晓燕[1] 王刚[1] 吴文萍[1] HUANG Hui;ZHENG Xiao-yan;WANG Gang;WU Wen-ping(Quzhou People's Hospital Affiliated to Wenzhou Medical University,Quzhou,Zhejiang 324000,China)

机构地区：[1]温州医科大附属衢州市人民医院,浙江衢州324000

出　　处：《中国卫生检验杂志》2022年第16期2005-2008,共4页Chinese Journal of Health Laboratory Technology

基　　金：衢州市科技局项目(2015064);浙江省科技厅公益技术研究社会发展项目(2013C33SA100139)。

摘　　要：目的 对急性早幼粒细胞白血病(APL)非正规治疗9年后完全缓解继发慢性粒细胞白血病(CML)一例进行分析。方法 运用骨髓细胞学、流式细胞学、融合基因检查及染色体核型分析检测方式对患者多次入院后的骨髓标本进行检测分析。结果 2012年第1次入院后流式白血病免疫分型提示:考虑为急性髓系白血病,倾向于M3。染色体核型分析提示:46,XY,t(15;17)(q22;q21)[9]/46,XY[1]。2021年第3次入院后流式白血病免疫分型提示:检测到表型轻度异常髓系原始细胞占有核细胞计数的0.3%和粒细胞比例增高伴抗原表达模式异常,未检测到异常早幼粒细胞。染色体核型分析提示:核型t(9;22)(q34;q11.2)[20]。结论 确定本报道中的患者APL发病时和CML确诊时的相关检查提供的信息表明,这2种发生在同一个体上的恶性血液病起源于2个不相关的细胞遗传学变异。提出可能与细胞毒药物长期使用有关的假设,并提出相关解决方案的可能。Objective To analyze a case of chronic myeloid leukemia(CML) secondary to complete remission after 9 years of informal treatment for acute promyelocytic leukemia(APL).Methods Bone marrow cytology,flow cytometry,fusion gene examination and chromosome karyotype analysis were used to detect and analyze the bone marrow samples of patients after multiple admissions,so as to assist clinicians in determining the diagnosis.Results Flow cytometric leukemia immunotyping after the first admission in 2012 suggested that acute myeloid leukemia was considered,with a preference for M3.Karyotype analysis showed 46,XY,t(15;17)(q22;q21)[9]/46,XY[1].After the third admission in 2021,flow cytometric leukemia immunotyping indicated that mild phenotypic abnormalities were detected in myeloid primordial cells accounting for 0.3% of nuclear cell count and increased proportion of granulocytes with abnormal antigen expression pattern,while no abnormal promyelocytic granulocytes were detected.Karyotype analysis showed karyotype t(9;22)(q34;q11.2)[20].Conclusion Tests to determine the onset of APL and the diagnosis of CML in the patients in this report provide information that the two hematologic malignancies occurring in the same individual arise from two unrelated cytogenetic variants.It suggests that the mutations may be associated with the long-term use of cytotoxic drugs,and possible solutions are proposed.

关 键 词：白血病 急性早幼粒细胞白血病 慢性粒细胞性白血病 

分 类 号：R556.5[医药卫生—血液循环系统疾病]