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伴有JAK2 V617F突变的急性髓系白血病治疗期间发生的原发性血小板增多症:一篇符合CARE标准文章的病例报告

Essential thrombocythemia during treatment of acute myeloid leukemia with JAK2 V617F mutation: A case report of a CARE-compliant article.

作者信息

Ding Wenwen, Li Danni, Zhuang Chao, Wei Pingping, Mou Wenfeng, Zhang Lei, Liang Hui, Liu Yong

机构信息

Department of Hematology Department of Laboratory, Qingdao Women and Children's Hospital Department of Anesthesiology, The Affiliated Hospital of Qingdao University, Qingdao, China.

出版信息

Medicine (Baltimore). 2018 Jul;97(27):e11331. doi: 10.1097/MD.0000000000011331.

Abstract

RATIONALE

The JAK2 V617F mutation is frequently found in ET, while it is rare in de novo AML. ET has a low frequency of leukemic transformation. Both secondary AML (sAML) from ET and AML with JAK2 V617F mutation have poor prognoses. Because of the low incidence of JAK2 mutation in acute myeloid leukemia (AML), the clinical features of AML with JAK2 mutation are rarely reported so far, either transformed from essential thrombocythemia (ET) or de novo AML.

PATIENT CONCERNS

In this article, we present a pediatric AML patient with the JAK2 V617F mutation.

DIAGNOSES

A diagnosis of acute megakaryoblastic leukemia was made and sAML was ruled out.

INTERVENTIONS

The patient underwent chemotherapy.

OUTCOMES

In the first two complete remission periods, we found significantly increased numbers of platelets and bone marrow megakaryocytes, which are characteristic of ET. After the third chemotherapy phase, the disease relapsed; the platelet count was reduced and continued to decrease. When disease relapsed, her family abandoned treatment.

LESSONS

These observations of our case raise two possibilities: either transient posttreatment thrombocythemia is a feature of AML with JAK2 V617F mutation, or this was a case of secondary AML. Additional information is required to reach better conclusions on the connection between AML and JAK2 mutations.

摘要

理论依据

JAK2 V617F突变在原发性血小板增多症(ET)中经常被发现,而在原发性急性髓系白血病(AML)中则很少见。ET发生白血病转化的频率较低。ET转化而来的继发性AML(sAML)以及伴有JAK2 V617F突变的AML预后都较差。由于急性髓系白血病(AML)中JAK2突变的发生率较低,迄今为止,很少有关于伴有JAK2突变的AML临床特征的报道,无论是由原发性血小板增多症(ET)转化而来还是原发性AML。

患者情况

在本文中,我们报告了一名患有JAK2 V617F突变的儿童AML患者。

诊断

诊断为急性巨核细胞白血病,排除了sAML。

干预措施

患者接受了化疗。

结果

在前两个完全缓解期,我们发现血小板和骨髓巨核细胞数量显著增加,这是ET的特征。在第三个化疗阶段后,疾病复发;血小板计数降低并持续下降。疾病复发时,她的家人放弃了治疗。

经验教训

我们对该病例的观察提出了两种可能性:要么治疗后短暂性血小板增多症是伴有JAK2 V617F突变的AML的一个特征,要么这是一例继发性AML。需要更多信息才能就AML与JAK2突变之间的联系得出更好的结论。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/780e/6076173/bf94f94cea8f/medi-97-e11331-g001.jpg

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