摘要
目的:报道1例合并克隆演变的伴t(8;16)(p11.2;p13.3)难治性治疗相关性急性髓性白血病(t-AML),并对相关文献进行复习。方法:应用骨髓细胞形态学、免疫分型、细胞遗传学和分子生物学的方法对该患者进行诊断和分型,并荟萃分析文献报道的88例伴t(8;16)(p11.2;p13.3)AML的临床资料。结果:本例患者为乳腺癌放化疗后1年发生t-AML,初诊时为单纯t(8;16)(p11.2;p13.3)核型,化疗1个疗程获得部分缓解,第2个疗程化疗后疾病进展并出现克隆演变,染色体核型复杂性逐渐增加,最多出现15种附加异常,继续化疗无效死亡,仅存活8个月。文献复习1987—2019年报道的88例t(8;16)(p11.2;p13.3)AML,t-AML占50.6%,中位生存时间为8个月,2年总生存率为24.3%,其中伴复杂异常核型患者的生存期更短(中位生存时间7个月vs 12个月,P=0.025),造血干细胞移植患者的生存优于非移植患者(中位生存时间23个月vs 6个月,P=0.036)。结论:伴t(8;16)(p11.2;p13.3) AML化疗后较易出现早期疾病进展,预后不良,克隆演变提示预后更差,尽早进行造血干细胞移植可能改善患者生存。
Objective:To report a case of refractory therapy-related acute myeloid leukemia(t-AML) with t(8;16)(p11.2;p13.3) accompanied by clonal evolution.Methods:Bone marrow morphology,immunophenotype,cytogenetics and molecular biology techniques were used for diagnosis and classification at the time of onset and follow-up period,and meta-analysis based on 88 AML patients with t(8;16)(p11.2;p13.3) from the literature was performed.Results:This patient was diagnosed with t-AML one year after chemotherapy and radiation for breast cancer.At onset,she had solely t(8;16)(p11.2;p13.3) abnormality and achieved partial remission after the first cycle induction chemotherapy.Then a progression of the disease and clonal evolution were observed after the second cycle of chemotherapy,and she obtained no response to subsequent treatment while the complexity of the chromosome karyotype was incremental and went up to fifteen additional abnormalities at last.The patient survived only 8 months.A meta-analysis of the reported 88 cases of t(8;16)(p11.2;p13.3) AML from 1987 to 2019 revealed that t-AML accounted for 50.6% and the 2-year overall survival rate was 24.3% with a median survival of 8 months.Patients with complex karyotypes had poor prognosis(median survival 7 months vs 12 months,P=0.025),while patients receiving hematopoietic stem cell transplantation had superior survival than those not(median survival 23 months vs 6 months,P=0.036).Conclusion:Early disease progression is prone to occur and confer to poor prognosis in patients with t(8;16)(p11.2;p13.3) AML,and clonal evolution is related to worse survival.Hematopoietic stem cell transplantation should be considered as early as possible to improve the survival in such patients.
作者
刘梦茹
宋文杰
王婧
党辉
师岩
何琦
王峥
赖悦云
LIU Mengru;SONG Wenjie;WANG Jing;DANG Hui;SHI Yan;HE Qi;WANG Zheng;LAI Yueyun(Peking University Peopled Hospital,Peking University Institute of Hematology,Beijing Key Laboratory of Hematopoietic Stem Cell Transplantation,National Clinical Research Center for Hematologic Disease,Beijing,100044,China)
出处
《临床血液学杂志》
CAS
2022年第3期201-206,共6页
Journal of Clinical Hematology
