化疗药物致治疗相关性白血病94例临床特点及分析

目的:检索并分析现有个案报道资料,为临床认识和预防治疗相关性白血病(TRL)并探索可能有效的治疗手段提供依据。方法:通过检索1979-2015年国内医药期刊报道的相关个案文献94例,对患者初始疾病、使用化疗药物种类、剂量以及治疗相关性白血病类型等数据进行统计和分析。结果:文献报道病例共94例,TRL常见类型主要为AML-M3、ML-M5和AML-M2。除遗传因素外,大剂量氮芥及类似物、亚硝基脲类、鬼臼毒素类和蒽环类药物是诱发TRL的高危化疗药物。骨髓移植、FLAG方案化疗和T细胞嵌合抗原受体治疗技术可用于TRL的治疗。结论:治疗相关性白血病应以预防为主,建议在治疗有效的前提下,尽可能减少高危化疗药物的累积剂量。

Analysis of clinical characteristics of 94 patients with leukemia caused by chemotherapy drugs

OBJECTIVE To provide the basis for cognition, prevention and effective treatment of therapy-related leukemia by analysis of literatures. METHODS Initial disease, type and dose of drugs and type of TRL in related literatures searched from 1978 to 2015 were reviewed and analyzed. RESULTS A total of 94 TRL cases were analyzed, and AML-M3, ML-M5 and AML-M2 were the most common types of TRL. High doses of nitrogen mustard, nitroso urea, ghost mortar toxins and anthracycline-based drugs were at high risks of inducing TRL except genetic factors. Hematopoietic stem cell transplantation, FLAG regimen and Chimeric antigen receptor T-cell therapy might be effective treatments against TRL. CONCLUSION TRL should be avoided mainly by prevention. Accumulation of high risk chemotherapy drugs should be reduced as possible under the prerequisite of effective therapy.