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目的探讨B细胞恶性肿瘤美罗华(rituximab)治疗后复发伴CD20抗原表达丢失患者的生物学特性。方法报道1例前体B细胞淋巴母细胞淋巴瘤/白血病(precursor-B-LBL/ALL)患者美罗华联合化疗治疗后复发时CD20抗原表达丧失,并进行文献复习。结果1例39岁男性前体B细胞淋巴母细胞淋巴瘤/白血病(pre-B-LBL/ALL)患者,初治时流式细胞(FCAS)检测瘤细胞表达CD19,CD20,CD22和CD25,弱表达CD34,而CD10表达阴性;免疫组化染色CD20广泛阳性;核型为92,XXYY,der(15)t(1;15)(q11;q26)×2[15]/46,XY[5]。经美罗华联合mBACOD诱导治疗2疗程后获得完全缓解(CR)。巩固化疗4疗程后,予美罗华、大剂量环磷酰胺(CTX)联合重组人源化粒细胞集落刺激因子(rh-G-CSF)动员、采集及冷冻保存自体外周血干细胞(PBSCs)。最后一疗程化疗4个月后患者复发,复发时流式细胞(FCAS)检测表达CD19,CD10,CD22,CD38和CD13,高表达CD34,而CD20,CD23和FMC7均阴性,免疫组化染色偶见CD20阳性细胞;核型转变为46,XY。结论B细胞恶性肿瘤美罗华治疗后复发患者应重新进行病理组织学、免疫表型和细胞/分子遗传学检测。
Objective To investigate the biological characteristics of patients with recurrent B-cell malignancies after rituximab loss of CD20 antigen expression. Methods One case of precursor B-cell lymphoblastic leukemia (precursor-B-LBL / ALL) was reported to have loss of CD20 antigen expression after recurrence of rituximab and to review the literature. Results In a 39-year-old male with pre-B-lymphoblastic leukemia (pre-B-LBL / ALL), CD19, CD20, CD22 and CD25 were detected by flow cytometry (FCAS) The expression of CD34 and CD10 was negative. Immunohistochemical staining for CD20 was widespread. The karyotype was 92, XXYY, der (15) t (1; 15) (q11; q26) × 2 [15] . The complete remission (CR) was achieved after 2 courses of treatment with rituximab and mBACOD. After 4 courses of consolidation chemotherapy, rituximab and high-dose cyclophosphamide (CTX) combined with recombinant humanized granulocyte colony-stimulating factor (rh-G-CSF) were mobilized to collect and cryopreserved autologous peripheral blood stem cells (PBSCs). In the last course of chemotherapy, the patients relapsed after 4 months of chemotherapy. FCAS detected the expression of CD19, CD10, CD22, CD38 and CD13, high expression of CD34, and negative of CD20, CD23 and FMC7 in recurrence. CD20-positive cells; karyotype transitions to 46, XY. Conclusions Patients with relapsed B-cell malignancies treated with rituximab should be re-histopathologically, immunophenotype, and cell / molecular genetic tests.