恶性实体瘤继发骨髓增生异常综合征急性髓系白血病11例分析

摘要

Objective:To investigate the etiology, clinical characteristics, and treatment of myelodysplastic syndrome/acute my-eloid leukemia (t-MDS/AML) secondary to malignant tumors. Methods: We retrospectively analyzed 11 patients with t-MDS/AML and investigated the treatment of primary tumors, clinical manifestations, treatment, and survival of t-MDS/AML patients. Results:A total of 11 patients were exposed to cytotoxic chemotherapeutic agents or radiation therapy for their primary tumors. The median laten-cy was 36 months. Common symptoms were fatigue, dyspnea, bleeding, and infection, all of which were related to deficits in hemato-poiesis. Therapeutic regimen included support therapy, immunomodulatory therapy, and chemotherapy. The median overall survival and disease-free survival periods were 28 months and 19 months, respectively, and the overall survival rate for 3 years was 44.4%. Conclu-sion:t-MDS/AML is a serious complication of chemotherapy or radiotherapy for a malignant or nonmalignant condition. The curative effect is limited, and prognosis is poor. Therefore, we should take t-MDS/AML into consideration when making treatment plans for can-cer patients to evaluate treatment benefits and to avoid treatment-related complications.%目的：探讨恶性肿瘤继发骨髓增生异常综合征/急性髓系白血病（t-MDS/AML）的病因、临床特点及治疗策略。方法：对2008年1月至2014年7月在天津医科大学肿瘤医院就诊的11例t-MDS/AML患者的临床资料进行回顾性分析。结果：11例恶性肿瘤患者前期均有不同程度的细胞毒药物、抗代谢药物、含紫杉类药物（和）或放射线治疗史，与t-MDS/AML确诊中位间隔时间为36个月；患者主要表现为乏力、呼吸困难、发热、出血等血细胞减少相关症状；以对症支持治疗，免疫调节治疗及化疗为主，中位OS为28个月，中位DFS为19个月，3年总生存率44.4%。结论：t-MDS/AML继发于肿瘤性疾病或非肿瘤性疾病行细胞毒药物化疗或放疗后，总体疗效欠佳，预后不良；在制定放、化疗方案前，应充分考虑可能导致t-MDS/AML的危险因素，认真评估治疗受益及风险。