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目的增加对治疗相关性继发白血病的认识。方法报道非霍奇金淋巴瘤治疗后2年继发急性髓细胞白血病M6型1例,结合文献讨论治疗相关性白血病的发病机制、治疗、预后。结果 1例73岁非霍奇金淋巴瘤患者接受R(Rituxmab,利妥昔单抗)-CHOP环磷酰胺+多柔比星+长春新碱+泼尼松方案规律化学治疗。治疗结束24+个月后,经骨髓涂片及细胞免疫分型诊断为急性髓细胞白血病M6型,染色体检查为:44～48,XY,del(5)(q12q33),-8,-10,der(12)t(4;12)(q11-q12;p13),其一般情况急剧恶化并死亡。结论治疗相关性白血病的发生可能与烷化剂等化疗药物使用和免疫受损等有关,利妥昔单抗导致第二肿瘤的发生暂时不能除外。治疗相关性白血病常伴有复杂染色体核型,其病情发展迅速,治疗效果差,生存期明显缩短。
Objective To increase awareness of treatment-related secondary leukemia. Methods One case of acute myeloid leukemia M6 type was reported 2 years after non-Hodgkin’s lymphoma treatment. The pathogenesis, treatment and prognosis of treatment-related leukemia were discussed in combination with the literature. Results A 73-year-old patient with non-Hodgkin’s lymphoma underwent R (Rituximab, Rituximab) -CHOP cyclophosphamide + doxorubicin + vincristine + prednisone regimen. After 24-month treatment, the diagnosis of acute myeloid leukemia M6 was made by bone marrow smear and cell immunophenotyping. The chromosomal examination was: 44-48, XY, del (5) (q12q33), -8, -10, der (12) t (4; 12) (q11-q12; p13), its general condition deteriorated rapidly and died. Conclusions The incidence of treatment-related leukemia may be related to the use of chemotherapeutic drugs such as alkylating agents and immune damage. Rituximab can not be temporarily excluded from the occurrence of the second tumor. Treatment-related leukemia often accompanied by complex karyotype, the rapid development of the disease, the treatment effect is poor, significantly shortened survival.