Faculty of Medicine, Trakya University, Balkan Yerleskesi 22030, Edirne, Turkey.
Department of Hematology, Trakya University, Balkan Yerleskesi 22030, Edirne, Turkey.
Natl Med J India. 2019 Nov-Dec;32(6):347-349. doi: 10.4103/0970-258X.303614.
Chronic lymphocytic leukaemia (CLL) is a heterogeneous disease with uncertain course. Treatment should be tailored to the patient's disease as well as the prognostic subgroup. With the increased use of rituximab as well as other selective and non-selective immunomodulatory agents, the incidence of infectious complications and second malignancies has also increased. Progressive multifocal leucoencephalopathy (PML) is a complication of rituximab in HIV-negative patients. A 56-year-old male with CLL had been treated and relapsed four times in 6 years. Rituximab was added to the combination after the second relapse and repeated in the third relapse in combination with bendamustine. In the seventh year of diagnosis, relapse of CLL and an ulcerated tumorous lesion was observed in the left index finger, which progressed in 3 months and was later diagnosed as angiosarcoma. The cancer was treated with local radiotherapy and combination chemotherapy. One year after the last rituximab exposure, progressive muscle weakness developed and polyoma JC virus DNA was observed with increased titres in the cerebrospinal fluid, and the patient was diagnosed as having PML. The patient died 2 months later. Our patient had an unusual course of CLL over 8 years, with relapses, complicated with a secondary malignancy and an infectious complication.
慢性淋巴细胞白血病（CLL）是一种异质性疾病，其病程不确定。治疗应根据患者的疾病以及预后亚组进行调整。随着利妥昔单抗以及其他选择性和非选择性免疫调节剂的广泛应用，感染性并发症和第二恶性肿瘤的发生率也有所增加。进行性多灶性白质脑病（PML）是 HIV 阴性患者使用利妥昔单抗的并发症。一名 56 岁男性患有 CLL，在 6 年内已接受过 4 次治疗且复发。第二次复发后，在第三次复发时添加了利妥昔单抗联合苯达莫司汀进行治疗。在诊断的第七年，CLL 复发并在左手食指上出现一个溃疡性肿瘤性病变，该病变在 3 个月内进展，后来被诊断为血管肉瘤。采用局部放疗和联合化疗治疗该癌症。在最后一次利妥昔单抗暴露后 1 年，出现进行性肌肉无力，脑脊液中发现多瘤 JC 病毒 DNA，且滴度升高，诊断为 PML。2 个月后患者死亡。我们的患者在 8 年多的时间里经历了异常的 CLL 病程，伴有复发、继发恶性肿瘤和感染性并发症。
