慢性淋巴细胞白血病合并急性髓系白血病多学科协作诊疗1例

天津医科大学肿瘤医院血液科2014年6月收治慢性淋巴细胞白血病（chronic lymphocytic leukemia，CLL）患者1例，该患者第1个周期化疗1个月后，在原有CLL细胞亚群的基础上发现另一群急性髓系白血病（acute myeloid leukemia，AML）细胞亚群。此后，虽然未经针对性治疗，但肿瘤在较长时间内（约11个月余）均呈现稳定状态。通过回顾患者前期的相关检查，明确此病例为极其罕见的CLL/AML。汇集综合血液科、分子诊断科、病理科等多学科的诊疗意见和延伸讨论，本研究通过此病例对CLL/AML、肿瘤二次打击学说与肿瘤树状演化模型有了比较全面和直观的认识。 

Multidisciplinary team confirmed the simultaneous diagnosis of CLL and AML-M5

A 54-year-old man diagnosed with chronic lymphocytic leukemia (CLL) was admitted in our department in June 2014. After one cycle of FC chemotherapy, a bone marrow examination revealed normalized lymphocyte count and another acute myeloid leuke-mia (AML)-M5 clone. The patient refused sequential treatment and only received follow-up examination. He had continuous hemato-logically stable disease and died of pulmonary infection on July 2015. After a multidisciplinary team discussion, we confirmed the si-multaneous diagnosis of CLL and AML-M5. Through this discussion,"tumor second hit model,""tumor evolution model,"and"tumor heterogeneity"were further defined.