肝炎相关性重型再生障碍性贫血免疫抑制治疗后发生淋巴瘤及肺癌首例报道及文献复习

摘要

目的 通过报道首例肝炎相关性重型再生障碍性贫血(HAAA)强化免疫抑制治疗(IST)后发生淋巴瘤及肺癌病例,结合文献复习,增强对HAAA病因、诊断及治疗的了解,并提高重型再生障碍性贫血(SAA)患者IST治疗后并发多重恶性肿瘤的认识.方法 针对该例患者进行了病例分析及相关文献复习.结果 患者在发生暴发性黄疸后出现急性再生障碍性贫血,以环孢菌素+抗人T淋巴细胞球蛋白(ATG)强化免疫抑制及抗肝炎病毒治疗后4个月发生弥漫大B细胞型淋巴瘤,虽经美罗华+COP方案化疗,迅速进展为骨髓浸润,并出现肺低分化腺癌.最终在患病10个月后因血象极其低下无法行化疗及无法控制的重症感染而死亡.结论 对HAAA患者除治疗SAA外,还应积极抗肝炎病毒治疗；SAA患者经IST后除可并发淋巴细胞增殖性疾病外,还可能并发其他恶性疾病,是SAA免疫抑制治疗的一种严重并发症,应引起高度警惕.%Objective To improve the comprehension of etiopathogenisis, diagnosis and treatment of hepatitis-associated aplastic anemia (HAAA) and the multiple malignancy after immune suppress treat-ment( IST). Methods The first case of lymphoma and lung cancer was reported after IST of HAAA and the literature was reviewed. Results After 4 months of IST (cyclosporin +ATG), the patient suffering from HAAA developed to patient with diffuse large B cell leukemia. Although the patient was accepted chemical treatment with anti-CD20 antibody and COP, the patient still deteriorated rapidly and followed by secondary poorly differentiated adenocarcinoma lung cancer. The patient finally died and total course of disease is only 10 months. Conclusion Inhibiting hepatitis virus is necessary for HAAA; in addition to the lymphocyte proliferating disease, the other malignancies usually are fatal which can be followed after IST.