非霍奇金淋巴瘤治疗后继发急性髓系白血病

为了探讨非霍奇金淋巴瘤（NHL）治疗相关性急性髓系白血病（t-AML）的可能发生机制、易感因素、18F-氟脱氧葡萄糖正电子发射计算机断层显像（18F—FDGPET／CT）表现及治疗方法。对1例NHL患者治疗后继发骨髓增生异常综合征（t-MDS）并随后又进展为t—AML的患者，进行了骨髓细胞形态学、流式细胞术和染色体核型检测，并结合18F—FDGPET／CT检测进行了分析。结果表明：该患者在治疗NHL时应用了包括CHOP方案在内的多种细胞毒性药物，从NHL化疗开始到t-MDS的发生间隔时间为105个月，又在2个月中转变为t-AML—M2。两次染色体核型检查均未见异常。18F-FDGPET／CT提示在t-MDS阶段患者全身骨骼FDG代谢弥漫性增高，选用CAG方案后获得缓解。结论：t-AML／MDS的发生可能与细胞毒性化疗药物的应用有关，18F—FDGPET／CT有可能是预测t-MDS向t-AML转化的检测指标之一。

Secondary Acute Myeloid Leukemia Complicated after Treatment of Non Hodgkin' s Lymphoma

The aim of this study was to investigate the mechanism, susceptibility, 18F-FDG positron emission computerized tomography （ 18 F-FDG PET/CT） features and the treatment of therapy-related acute myeloid leukemia. One patient with NHL was affected with t-MDS after treatment and then progressed to t-AML. The clinical data including bone marrow cell morphology, flow cytometry, karyotype and PET/CT features were analyzed. The results showed that the primary treatment for NHL refers to varieties of cytotoxic drug such as cyclophosphamidehydroxydaunomycin-oncovin-prednisone （CHOP） chemotherapy, The interval time from the chemotherapy of NHL to the occurrence of t-MDS was 105 months and t-MDS progressed to AML-M2 in 2 months. Karyotype analysis results of t-MDS and t-AML were normal. 18F-FDG PET indicated that the FDG uptake in the bone raised diffusely. The patient showed complete response after second-line therapy （ CAG regiments）. In conclusion, the occurrence of t-AML/MDS may be associated with the application of the cytotoxic chemotherapeutics. 18F-FDG PET may be an indicator predicating the transformation of t-MDS to t-AML.