异基因外周血干细胞移植后的心膈角髓肉瘤★

摘要

背景：异基因造血干细胞移植是治愈白血病的主要方法，但经过异基因造血干细胞移植的患者仍面临着复发的风险，髓肉瘤为一种罕见的髓外复发方式，且临床疗效差，因此了解髓肉瘤的特点及治疗方法十分必要。目的：分析异基因外周血干细胞移植后髓肉瘤的临床特点及治疗方法。方法：异基因外周血干细胞移植后并发心膈角髓肉瘤患者1例，先后予手术切除肿块、化疗、放疗等联合方法治疗，观察临床疗效及相关并发症和生存情况。结果与结论：患者在2个疗程的化疗过程中出现了败血症、真菌性肺炎及感染性休克等并发症，之后接受了纵隔放疗，髓肉瘤未再复发。无病生存25个月后出现中枢神经系统白血病。造血干细胞移植后髓肉瘤罕见且临床表现多变，主要依靠病理组织学和免疫组化检查确诊。可采用手术、化疗、放疗、二次移植和分子靶向治疗等方法，但个体化的治疗方案仍需进一步探讨。%BACKGROUND: Al ogeneic hematopoietic stem cel transplantation is the main method to cure leukemia, but the patients receiving al ogeneic hematopoietic stem cel transplantation stil have to face the risk of recurrence. Myeloid sarcoma is a rare extramedul ary relapse mode with worse clinical outcomes, so it is necessary to understand the characteristics of myeloid sarcoma and relative treatment methods. OBJECTIVE: To analyze the clinical characteristics and treatment methods of myeliod sarcomas in cardio-phrenic angle after al ogeneic peripheral blood stem cel transplantation. METHODS: One case was diagnosed as single myeloid sacoma in the cardio-phrenic angle after al ogeneic peripheral blood stem cel transplantation. The patient underwent surgical resection of the mass, chemotherapy and radiotherapy. The clinical effect, complications and survival situation were observed. RESULTS AND CONCLUSION: The patient suffered from bacteremia, fungal pneumonia and even life-threatening sepsis shock during two courses chemotherapies. Then, the patient received radiotherapy for mediastinum and the myeloid sacoma never relapsed. However, the patient suffered central nervous system leukemia after free of the disease for 25 months. Myeliod sarcoma after al ogeneic hematopoietic stem cel transplantation is rare and its manifestation is changeful. The diagnosis mainly depends on histopathology and immunohistochemistry. Surgery, chemotherapy, radiotherapy, second transplantation and molecular targeted drugs are the choices of treatment strategy. However, the optimal treatment strategy for individual patients remains to be determined.