中华儿科杂志
中華兒科雜誌
중화인과잡지
Chinese Journal of Pediatrics
2013年
12期
938-942
,共5页
淋巴组织细胞增多症,嗜血细胞性%白血病%依托泊甙
淋巴組織細胞增多癥,嗜血細胞性%白血病%依託泊甙
림파조직세포증다증,기혈세포성%백혈병%의탁박대
Lymphohistiocytosis,hemophagocytic%Leukemia%Etoposide
目的 探讨噬血细胞综合征依托泊苷治疗相关白血病的临床特点和风险.方法 报告1例噬血细胞综合征患儿应用依托泊苷治疗后继发急性早幼粒细胞白血病的临床资料,并结合国内外报道的噬血细胞综合征治疗后继发白血病的10例病例进行文献复习.结果 本例明确诊断EB病毒相关噬血细胞综合征,依托泊苷累积剂量3520 mg/m2,在确诊噬血细胞综合征后28个月,被诊断急性早幼粒细胞白血病,给予维甲酸+去甲氧柔红霉素诱导化疗缓解,继续给予巩固治疗.复习文献发现10例噬血细胞综合征治疗后继发白血病病例,与本例共11例,应用依托泊苷累积剂量900 ～20 500 mg/m2,噬血细胞综合征与继发白血病间隔中位时间24个月.继发白血病类型包括1例急性淋巴细胞白血病,1例骨髓增生异常综合征,9例急性髓细胞白血病.3例出现了染色体11q23异常,4例急性早幼粒细胞白血病病例出现t(15；17)染色体异常.11例病例中死亡4例,存活7例.结论 依托泊苷治疗相关白血病潜伏期短、急性髓细胞白血病常见、平衡染色体异常常见.依托泊苷治疗相关白血病发生的危险因素与依托泊苷累积剂量、应用频率、联合其他抗肿瘤药物多因素有关.在噬血细胞综合征化疗中保持依托泊苷累积剂量在一个安全剂量范围,以减少继发白血病的发生.
目的 探討噬血細胞綜閤徵依託泊苷治療相關白血病的臨床特點和風險.方法 報告1例噬血細胞綜閤徵患兒應用依託泊苷治療後繼髮急性早幼粒細胞白血病的臨床資料,併結閤國內外報道的噬血細胞綜閤徵治療後繼髮白血病的10例病例進行文獻複習.結果 本例明確診斷EB病毒相關噬血細胞綜閤徵,依託泊苷纍積劑量3520 mg/m2,在確診噬血細胞綜閤徵後28箇月,被診斷急性早幼粒細胞白血病,給予維甲痠+去甲氧柔紅黴素誘導化療緩解,繼續給予鞏固治療.複習文獻髮現10例噬血細胞綜閤徵治療後繼髮白血病病例,與本例共11例,應用依託泊苷纍積劑量900 ～20 500 mg/m2,噬血細胞綜閤徵與繼髮白血病間隔中位時間24箇月.繼髮白血病類型包括1例急性淋巴細胞白血病,1例骨髓增生異常綜閤徵,9例急性髓細胞白血病.3例齣現瞭染色體11q23異常,4例急性早幼粒細胞白血病病例齣現t(15；17)染色體異常.11例病例中死亡4例,存活7例.結論 依託泊苷治療相關白血病潛伏期短、急性髓細胞白血病常見、平衡染色體異常常見.依託泊苷治療相關白血病髮生的危險因素與依託泊苷纍積劑量、應用頻率、聯閤其他抗腫瘤藥物多因素有關.在噬血細胞綜閤徵化療中保持依託泊苷纍積劑量在一箇安全劑量範圍,以減少繼髮白血病的髮生.
목적 탐토서혈세포종합정의탁박감치료상관백혈병적림상특점화풍험.방법 보고1례서혈세포종합정환인응용의탁박감치료후계발급성조유립세포백혈병적림상자료,병결합국내외보도적서혈세포종합정치료후계발백혈병적10례병례진행문헌복습.결과 본례명학진단EB병독상관서혈세포종합정,의탁박감루적제량3520 mg/m2,재학진서혈세포종합정후28개월,피진단급성조유립세포백혈병,급여유갑산+거갑양유홍매소유도화료완해,계속급여공고치료.복습문헌발현10례서혈세포종합정치료후계발백혈병병례,여본례공11례,응용의탁박감루적제량900 ～20 500 mg/m2,서혈세포종합정여계발백혈병간격중위시간24개월.계발백혈병류형포괄1례급성림파세포백혈병,1례골수증생이상종합정,9례급성수세포백혈병.3례출현료염색체11q23이상,4례급성조유립세포백혈병병례출현t(15；17)염색체이상.11례병례중사망4례,존활7례.결론 의탁박감치료상관백혈병잠복기단、급성수세포백혈병상견、평형염색체이상상견.의탁박감치료상관백혈병발생적위험인소여의탁박감루적제량、응용빈솔、연합기타항종류약물다인소유관.재서혈세포종합정화료중보지의탁박감루적제량재일개안전제량범위,이감소계발백혈병적발생.
Objective To explore the characteristics and risk of etoposide-related leukemia in the treatment of hemophagocytic lymphohistiocytosis (HLH).Method Clinical characteristics of a case with secondary acute promyelocytic leukemia (APL) were summarized and 10 cases of secondary leukemia after treatment for HLH from literature were analyzed.Result The child was diagnosed with Epstein-Barr virus associated HLH and received HLH-2004 protocol.The cumulative dose of etoposide (VP16) was 3520 mg/m2.The patient was diagnosed with APL after 28 months of HLH.He achieved complete remission after induction chemotherapy of all-trans-retinoic acid and darubicin.Consolidated chemotherapy was continued.There were 10 reports of etoposide-related leukemia after treatment for HLH in the literature.Review of 11 cases treated with VP16,of which cumulative doses were 900-20 500 mg/m2.The interval period between HLH and secondary leukemia was 24 months.The types of secondary leukemia included 1 case with acute lymphoblastic leukemia,1 case with myelodysplastic syndrome and 9 cases of acute myeloid leukemia.The abnormalities of chromosome included 3 patients with 11q23,3 APL patients with t (15,17).Seven patients survived and 4 died.Conclusion The latency period of etoposide-related leukemia is short.Acute myeloid leukemia and balanced chromosomal abnormality are common in etoposiderelated leukemia.The risk factors for development of secondary leukemia are related to cumulative drug doses of etoposide,treatment schedules and co-administration of other antineoplastic agents.It is appropriate to keep suitable range of the cumulative dose of etoposide in HLH therapy in order to reduce the risk of therapy related leukemia.
