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本文作者复习s年英文文献,发现33例急性淋巴细胞白血病(ALL)后来发生第二种肿瘤。其中7例在 ALL 诊断后的3～8个月发生组织细胞性髓性网状细胞增生症(HMR)。年龄4～17岁,男5例,女2例,均于发生 HMR 后短期内死亡。4例在 ALL诊断后10～21个月发生何杰金氏病,年龄5～18岁,男女各2例。有趣的是其组织学特点为淋巴细胞减少或表现为混合细胞型改变,而不是常见的结节硬化型和淋巴细胞为主型。尽管组织学表现预示不利,但这些患儿对初期治疗的反应均较好。9例在 ALL 诊断后10个月～15年发生另一类型的急性白血病,通常是急性粒细胞白血病(AML)。这种转变提示可能在ALL 诊断时另一株恶性的克隆已存在,但当时受到抑制,在对 ALL 化疗后这株克隆才暴露出来。4例在 ALL 诊断后1～3年表现为慢性粒细胞白血病(CML)。在 CML 出现时均曾作细胞遗传学研究,3例未发现 ph~1染色体,提示是青少年型 CML。可
The authors reviewed s-year English literature and found that 33 cases of acute lymphoblastic leukemia (ALL) followed by a second tumor. Seven of these patients developed histiocytic myelocytic hyperplasia (HMR) 3 to 8 months after ALL diagnosis. Age 4 to 17 years old, 5 males and 2 females, all died shortly after HMR occurred. Four patients developed Hodgkin’s disease 10 to 21 months after diagnosis, with a mean age of 5 to 18 years and 2 males and 2 females. Interestingly, histological features are characterized by lymphopenia or a mixed cell type change, rather than the common nodular sclerosis and lymphocyte predominance. Despite the unfavorable histological findings, these children responded better to initial treatment. Nine patients developed another type of acute leukemia, usually acute myeloid leukemia (AML), 10 months to 15 years after ALL diagnosis. This shift suggests that another malignant clone may have been present at the time of ALL diagnosis but was then inhibited and this clone was exposed after ALL chemotherapy. Four cases showed chronic myeloid leukemia (CML) 1 to 3 years after ALL diagnosis. Cytogenetics was performed in the presence of CML, and ph ~ 1 chromosome was not found in 3 cases, suggesting that adolescent CML. can