中医药治疗多发性骨髓瘤继发急性淋系白血病1例并文献复习  

Treatment of acute lymphoblastic leukemia secondary to multiple myeloma with traditional Chinese medicine:One case and literature review

作　　者：车明璐 张雅月[1] 严香 赵倩[1] 许亚梅[1] CHE Minglu;ZHANG Yayue;YAN Xiang;ZHAO Qian;XU Yamei(Department of Hematology and Oncology,Dongzhimen Hospital,Beijing University of Chinese Medicine,Beijing 100700,China)

机构地区：[1]北京中医药大学东直门医院,北京100700

出　　处：《现代肿瘤医学》2023年第17期3252-3257,共6页Journal of Modern Oncology

基　　金：国家自然科学基金青年科学基金项目(编号:81703903)。

摘　　要：目的:本病例报道验证复方浙贝颗粒治疗急性白血病的显著疗效,以期为中西医结合临床诊疗提供参考。方法:本文报道一例老年多发性骨髓瘤患者持续CR四年后继发急性淋系白血病的病例,结合国内外相关文献,针对来那度胺继发第二肿瘤的发病机制进行分析,同时对中医药治疗难治性急性淋巴细胞白血病进行辨证分析。结果:患者单纯应用中医药治疗后,流式细胞术检查示异常幼稚细胞由41.3%(2021年11月)降低至1.25%(2023年02月)。总结出长期应用来那度胺继发SPM相关机制,但总体上治疗获益超过SPM风险,大多数患者死亡是由于疾病进展而非SPM。结论:本病例启示临床医生在使用免疫调节药物时需对患者进行定期随诊,警惕SPM的发生。复方浙贝颗粒以“化痰散结、活血化瘀”为治则,且大量临床研究证实,复方浙贝颗粒联合化疗可减轻急性白血病患者的临床症状,提高临床缓解率。Objective:This case report verifies the remarkable efficacy of compound Zhebei granules in the treatment of acute leukemia,in order to provide reference for the clinical diagnosis and treatment of integrated Chinese and western medicine.Methods:This paper reported a case of secondary acute leucogenous leukemia in an elderly patient with multiple myeloma who sustained CR for 4 years.Combined with relevant literature at home and abroad,the pathogenesis of lenalidomide secondary tumor was analyzed,and the syndrome differentiation of refractory acute lymphoblastic leukemia treated by traditional Chinese medicine was analyzed.Results:After traditional Chinese medicine alone,flow cytometry showed that abnormal naive cells decreased from 41.3%(November 2021)to 1.25%(February 2023).The mechanism of secondary SPM associated with long-term lenalidomide use was summarized,but overall the benefit of treatment outweighed the risk of SPM,and most patient deaths were due to disease progression rather than SPM.Conclusion:This case suggests that clinicians should follow up patients regularly when using immunomodulatory drugs to be alert to the occurrence of SPM.Compound Zhebei granules take"Relieve phlegm"and"Promote blood circulation"as the treatment principle,and a large number of clinical studies have confirmed that compound Zhebei granules combined with chemotherapy can reduce the clinical symptoms of patients with acute leukemia and improve the clinical remission rate.

关 键 词：多发性骨髓瘤 中医药 来那度胺 继发第二肿瘤 难治性急性淋巴细胞白血病 

分 类 号：R733.3[医药卫生—肿瘤]