妊娠合并急性白血病39例临床特征及预后分析

目的 探讨妊娠合并急性白血病(AL)患者的临床特征及预后情况.方法 收集2010年1月至2017年4月在郑州大学第一附属医院血液科就诊的39例单胎妊娠合并AL患者临床资料,回顾性分析其临床特征及预后情况.结果 除孕前发病1例外,妊娠早、中、晚期AL患者所占比例分别为23.7％(9/38)、52.6％(20/38)、23.7％(9/38).共31例患者接受化疗,妊娠早、中、晚期患者化疗完全缓解(CR)率分别为71.4％(5/7)、94.1％(16/17)、100.0％(7/7).31例流产或引产,8例剖宫产产下活婴.22例存在染色体核型异常,主要为与分型相关的特异性染色体重排;AML患者高表达CD117、CD13、CD33、CD38,ALL患者高表达CD19、CD38、CD22、cCD79a、CD58.诱导治疗后微小残留病(MRD)阳性的10例患者CR7例,CR后复发4例,死亡7例,而MRD阴性患者19例均获CR,CR后复发5例,死亡9例.所有患者中,29例为AML,10例为ALL,CR率分别为95.7％(22/23)、75.0％(6/8).所有患者1年生存率53.1％,2年生存率26.4％,其中AML患者生存率高于ALL患者.结论 妊娠合并AL患者临床特征复杂,需全面综合处理;MRD是预后判断的重要指征;ALL患者预后较AML差.

Clinical features and prognosis of acute leukemia in pregnancy: an analysis of 39 cases

Objective To investigate the clinical features and prognosis of patients with acute leukemia (AL) in pregnancy.Methods The clinical data of 39 cases of acute leukemia in pregnancy at the First Affiliated Hospital of Zhengzhou University from January 2010 to April 2017 were collected.The clinical characteristics and prognosis were analyzed retrospectively.Results Except one case diagnosed before pregnancy,the incidence rates of AL in early,middle and late stage of pregnancy were 23.7 ％ (9/38),52.6 ％ (20/38) and 23.7 ％ (9/38),respectively.31 patients received chemotherapy and the complete response (CR) rates of AL patients in early,middle and late stage of pregnancy were 71.4 ％ (5/7),94.1％ (16/17),and 100.0 ％ (7/7),respectively.Among all the cases,31 patients received a miscarriage or induction of labor,and 8 cases had live births delivered by cesarean section.Twenty-two patients had abnormal karyotypes,which was mainly related to specific chromosomal rearrangement.Acute myeloid leukemia (AML) patients expressed high levels of CD117,CD13,CD33,and CD38,and acute lymphoblastic leukemia (ALL) patients had high expression of CD19,CD38,CD22,cCD79a,and CD58.After induction therapy,10 cases got positive minimal residual disease (MRD),7 of which achieved CR.After that,4 cases recurred,and 7 cases died in total.On the other hand,all the 19 MRD-negative patients achieved CR.Then,5 cases recurred,and 9 cases died intotal.In all patients,29 were AML while the other 10 were ALL,the CR rates in AML and ALL were 95.7 ％ (22/23) and 75.0 ％ (6/8),and the 1-year and 2-year survival rate were 53.1％ and 26.4 ％,respectively.The survival rate of AML patients was higher than that of ALL patients.Conclusions The clinical characteristics of AL patients in pregnancy are complicated and comprehensive treatment is needed.MDR is an important indicator of prognosis,and the prognosis of ALL is worse than that of AML.