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目的探讨急性白血病与恶性实体肿瘤迭合时实体肿瘤和急性白血病的类型、血象及骨髓象改变、病程及预后。方法收集本院近5年来收治的恶性实体肿瘤迭和急性白血病8例,参照2008年WHO分类诊断标准重新复核其骨髓形态学改变,结合文献分析恶性实体肿瘤迭和急性白血病的临床特点。结果 8名恶性实体肿瘤迭和急性白血病患者中7例发病间隔时间>6个月(中位值2年),其中2例手术后行化疗,3例手术后行放化疗,1例化疗后行局部放疗,1例行酒精注射治疗;1例发病间隔时间<1月。急性白血病的骨髓形态学改变:6例有病态造血,包括6例均有粒系病态造血,4例又有红系病态造血,2例又有巨核系病态造血,2例伴有噬血现象。死亡5例,生存时间2～10(中位值5)个月,存活3例,仍在治疗中。结论恶性实体肿瘤迭和急性白血病的发生与放化疗及宿主内在因素有关,肿瘤相关性白血病细胞形态多见明显的病态造血,病程进展较快,常规化疗效果及预后很差,应根据行为状态和核型选择治疗方案。
Objective To investigate the types, hematopoiesis and bone marrow changes, pathological and prognosis of solid tumors and acute leukemias in acute leukemia and malignant solid tumor. Methods Eight cases of malignant solid tumor and acute leukemia admitted in our hospital in recent 5 years were collected. The histological changes of bone marrow were rechecked according to the diagnostic criteria of WHO in 2008. The clinical features of malignant solid tumors and acute leukemia were analyzed. Results Of the 8 patients with malignant solid tumor and acute leukemia, 7 patients had an interval of more than 6 months (median 2 years), of whom 2 received postoperative chemotherapy, 3 received postoperative chemoradiotherapy and 1 received chemotherapy Local radiotherapy, 1 case of alcohol injection treatment; 1 case of onset interval <1 month. Bone marrow morphological changes of acute leukemia: 6 patients had morbid hematopoietic, including 6 patients with pathological hematopoiesis of granulocytes, 4 patients with erythroid morbid hematopoiesis, 2 patients with megakaryocytopoiesis and 2 patients with hemophagocytosis. 5 died, survival time 2 to 10 (median 5) months, survived in 3 cases, still under treatment. Conclusions The occurrence of malignant solid tumor Diego and acute leukemia is related to chemoradiotherapy and host intrinsic factors. The morphology of tumor-associated leukemia cells is more obvious morbidly hematopoietic. The course of disease progression is faster. The conventional chemotherapy and prognosis are poor. Karyotype treatment options.