急性髓系白血病合并小B细胞淋巴瘤1例并文献复习  

Acute myeloid leukemia combined with small B-cell lymphoma coexisting in the bone marrow: A case report and literature review

作　　者：汪智琼 刘娴 孟凡凯[1] 黄丽芳 WANG Zhiqiong;LIU Xian;MENG Fankai;HUANG Lifang(Department of Hematology,Tongji Hospital,Tongji Medical College,Huazhong University of Science and Technology,Wuhan 430030,China)

机构地区：[1]华中科技大学同济医学院附属同济医院血液内科,武汉430030

出　　处：《临床与病理杂志》2022年第9期2320-2326,共7页Journal of Clinical and Pathological Research

基　　金：国家自然科学基金(81500082)。

摘　　要：急性髓系白血病(acute myeloid leukemia,AML)同时在骨髓中合并小B细胞淋巴瘤非常罕见。本文报道1例AML同时在骨髓中合并小B细胞淋巴瘤患者,该患者初诊时骨髓中原始粒细胞占86%,外周血中原始粒细胞占50%,异常淋巴细胞占25%。骨髓活检病理综合考虑AML,细胞遗传学检查:45, XY,–21[4]/45, XY,–3,+12,–21[2]/46, XY[14]。患者行伊达比星联合阿糖胞苷(IA方案)化疗,2周后骨髓中原始粒细胞占28%,异常淋巴细胞占64%;再次使用IA方案并加用地塞米松每天10 mg继续治疗,2周后骨髓中原始粒细胞未见,异常淋巴细胞占79%;改行利妥昔单抗-环磷酰胺+长春新碱+阿霉素+强的松(R-CHOP)化疗,半年后骨髓中原始粒细胞占97%;再次给予吡柔比星联合阿糖胞苷(TA方案)化疗,3月后患者死亡。在治疗过程中原始粒细胞与异常淋巴细胞此消彼长,对髓系及淋系治疗反应差,患者生存时间短。结合患者临床资料及治疗转归,并进行文献复习,进一步提高对AML合并小B细胞淋巴瘤的认识。Acute myeloid leukemia(AML) combined with small B-cell lymphoma in the bone marrow is very rare. This article reported a case of typical AML with synchronous small B-cell lymphoma in the bone marrow. At the early onset, the bone marrow blasts, peripheral blood blasts and the abnormal lymphocytes accounted for 86%, 50%, and 25%, respectively. AML was taken into consideration based on pathology and immunohistochemistry result of bone marrow biopsy. Cytogenetic examination reported 45, XY, –21[4]/45, XY, –3, +12, –21[2]/46, XY[14]. The patient was treated with idarubicin combined with cytarabine(IA regimen) chemotherapy. A?ter 2 weeks, bone marrow blasts decreased to 28%, while abnormal lymphocytes increased to 64%. The patient was treated with IA regimen again in addition with dexamethasone(10 mg/d). Two weeks later, no blasts were found in the bone marrow, but the abnormal lymphocytes still accounted for 79%. The patient was treated with R-CHOP chemotherapy. Half a year later, the bone marrow blasts accounted for 97%. He was given piraubicin combined with cytarabine(TA regimen) chemotherapy for 3 months before his death. During the whole process of treatment, the ebb and flow of bone marrow blasts and abnormal lymphocytes indicated poor response to myeloid and lymphatic treatments and short survival. Combined with the clinical data, treatment outcome and literature review, we can further improve the understanding of AML with synchronous small B-cell lymphoma in the bone marrow.

关 键 词：多原发性恶性肿瘤 急性髓系白血病 淋巴瘤 骨髓共存 

分 类 号：R733[医药卫生—肿瘤]