恶性实体肿瘤迭和急性白血病临床特点分析

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。

The clinical characteristics of malignant solid tumor superimposed with acute leukemia

Objective To explore the type of peripheral blood,bone marrow picture,course of disease and prognosis of solid malignant neoplasm superimposed with acute leukemia.Methods 8 cases of malignant solid tumors superimposed with acute leukemia admitted to our hospital for the past five years were collected.Refer to the diagnostic criteria of 2008 WHO classification of tumors of haematopoietic and lymphoid tissues to review the bone marrow morphology,combined with the literatures to describe the clinical characteristics.Results In the 8 patients of malignant solid tumors superimposed with acute leukemia,Onset intervals of 7 cases> 6 months,median time was 2 years;2 cases of the 7cases received chemotherapy after surgery,3 cases received radiotherapy and chemotherapy after surgery,one received chemotherapy after radiotherapy,one received alcohol injection treatment.Onset interval of one case<1 month.Morphology of bone marrow:6 patients associated with dysplasia,dysgranulopoiesis was present in 6 cases,dyserythropoiesis in 4 cases,megakaryocytic dysplasia in 2 cases,hemophagocytic phenomenon in 2 cases.5 patients died,and the median survival time was 5 months,3 cases are still under treatment.Conclusion Solid malignant neoplasm superimposed with leukemia are associated with radiotherapy,chemotherapy and the internal host factors,significant dysplasia is present in the majority of tumor-associated leukemias,response to conventional chemotherapy and prognosis are poor,Patients should be treated according to performance status and karyotype.