霍奇金淋巴瘤治疗后继发急性髓系白血病伴染色体核型inv(16)一例并文献复习

摘要

目的 提高对治疗相关白血病的认识.方法 报道1例霍奇金淋巴瘤(HL)治疗后继发急性髓系白血病(AML)伴inv(16)患者的诊治过程,并结合文献复习治疗相关白血病的发病机制、治疗及预后.结果 该例36岁女性患者在确诊HL并接受规范淋巴瘤化疗后2年确诊为治疗相关白血病.染色体核型分析显示inv(16),且聚合酶链反应(PCR)结果提示CBFβ/MYH11融合基因阳性.经3个疗程化疗后,患者CBFβ/MYH11基因仍为阳性.该患者行半相合外周血造血干细胞移植后取得分子生物学缓解.患者一般情况良好,现无白血病生存时间1.5年.结论 治疗相关白血病治疗难度大,但其具有异质性.细胞遗传学及分子生物学对于治疗相关白血病预后有重要的提示意义.目前异基因造血干细胞移植为唯一可以治愈治疗相关性AML的有效方式.%Objective To improve the recognition of therapy-related acute myeloid leukemia (t-AML). Methods One patient who was diagnosed as AML with inv (16) following treatment of Hodgkin lymphoma (HL) was reported. The pathomechanism, diagnosis, treatments and prognosis of t-AML were systematically studied by reviewing a series of literature. Results A 36-year-old female with a history of HL 2 years ago was diagnosed t-AML. Karyotype analysis demonstrated inv (16) and the fusion gene of CBFβ/MYH11 was positive by polymerase chain reaction (PCR). The fusion gene of CBFβ/MYH11 was still positive after receiving 3 courses of chemotherapy. The leukemia reached completely molecular biological remission after receiving haploidentical peripheral blood stem cell transplantation. The patient has now survived 1.5 years with leukemia free and in a good performance. Conclusions The t-AML is difficult to treat, but it is heterogeneous. Cytogenetics and molecular biology have important implications for the prognosis of t-AML. Currently, allogeneic hematopoietic stem cell transplantation is the only effective way to cure t-AML.