急性髓系白血病与慢性淋巴细胞白血病的同步诊断与治疗：两例报告
Synchronous diagnosis and treatment of acute myeloid leukemia and chronic lymphocytic leukemia: Two case reports.
作者信息
Chen Rong-Rong, Zhu Li-Xia, Wang Lu-Lu, Li Xue-Ying, Sun Jia-Nai, Xie Mi-Xue, Zhu Jing-Jing, Zhou De, Li Jian-Hu, Huang Xin, Xie Wan-Zhuo, Ye Xiu-Jin
机构信息
Department of Hematology, The First Affiliated Hospital, College of Medicine, Zhejiang University, Hangzhou 310003, Zhejiang Province, China.
出版信息
World J Clin Cases. 2021 Oct 26;9(30):9144-9150. doi: 10.12998/wjcc.v9.i30.9144.
BACKGROUND
The concurrence of acute myeloid leukemia (AML) and chronic lymphocytic leukemia (CLL) is rare. Previous reports of such cases have focused mainly on clinical diagnosis and characteristics, so the mechanism remains unclear, and therapy options have been poorly explored.
CASE SUMMARY
Here, we report two cases of synchronous AML and CLL. Flow cytometry revealed two distinct abnormal cell populations (myeloblasts and lymphoid cells) according to scatter characteristics. CD5-positive B cell lymphoma with myeloid leukemia invasion was observed on lymph node biopsy. Chemotherapy regimens indicated for both AML and CLL were used in our patients, and our patients achieved complete response after chemotherapy. Next-generation sequencing of 88 genes was performed.
CONCLUSION
We conclude that early mutation and dysregulation at the hematopoietic stem cell stage and the accumulation of multiple rearrangements may cause the concurrence of CLL and AML. The treatment of infection and combination therapy aimed at the CLL component are significant in the management of patients with concurrent CLL and AML.
背景
急性髓系白血病（AML）与慢性淋巴细胞白血病（CLL）并发的情况较为罕见。既往此类病例报告主要集中于临床诊断和特征，因此发病机制仍不明确，且治疗方案探索较少。
病例总结
在此，我们报告两例AML与CLL同步发生的病例。流式细胞术根据散射特征显示出两个不同的异常细胞群（原始粒细胞和淋巴细胞）。淋巴结活检发现伴有髓系白血病浸润的CD5阳性B细胞淋巴瘤。我们的患者采用了针对AML和CLL的化疗方案，化疗后达到完全缓解。对88个基因进行了二代测序。
结论
我们得出结论，造血干细胞阶段的早期突变和失调以及多种重排的积累可能导致CLL和AML并发。感染的治疗以及针对CLL成分的联合治疗在CLL和AML并发患者的管理中具有重要意义。
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