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病例研究:单倍体相合造血干细胞移植治疗有效后出现急性浆细胞白血病

Case study: Acute plasmoblastic leukemia presentation following effective haploidentical hematopoietic stem cell transplantation therapy.

作者信息

Karabekov Azat, Abdirgalieva Madina, Najipova Aigerim, Kemaykin Vadim, Kolesnikova Olga, Vildanova Ruzal, Manatova Almira, Kuanysh Zhuldyz

机构信息

Center for Oncohematology and Bone Marrow Transplantation, National Research Oncology Center, Astana, Kazakhstan.

Department of Science, National Research Oncology Center, Astana, Kazakhstan.

出版信息

J Int Med Res. 2025 Mar;53(3):3000605251326804. doi: 10.1177/03000605251326804. Epub 2025 Mar 28.

Abstract

Plasma cell leukemia is a rare and aggressive malignancy characterized by monoclonal gammopathy and the presence of circulating plasma cells in the peripheral blood. Therapeutic strategies for plasma cell leukemia remain undefined, with treatments primarily borrowed from those used in multiple myeloma. The first-line treatment typically involves a combination of a proteasome inhibitor, an immunomodulatory agent, steroids, and/or anthracyclines and alkylators within an intensive chemotherapy regimen. Following this, consolidation with autologous hematopoietic stem cell transplantation is offered to eligible patients, followed by maintenance therapy. For patients ineligible for autologous hematopoietic stem cell transplantation, allogeneic hematopoietic stem cell transplantation is considered a viable alternative. Given the challenges in securing a fully human leukocyte antigen-matched donor, haploidentical hematopoietic stem cell transplantation serves as a potential salvage therapy, as demonstrated in the clinical case presented. This article presents the case of a female patient in her 50s diagnosed with plasma cell leukemia who, following unsuccessful autologous hematopoietic stem cell mobilization, underwent haploidentical hematopoietic stem cell transplantation from her son, resulting in complete donor chimerism and a favorable response.

摘要

浆细胞白血病是一种罕见且侵袭性的恶性肿瘤,其特征为单克隆丙种球蛋白病以及外周血中存在循环浆细胞。浆细胞白血病的治疗策略仍不明确,治疗方法主要借鉴用于多发性骨髓瘤的那些。一线治疗通常包括在强化化疗方案中联合使用蛋白酶体抑制剂、免疫调节剂、类固醇和/或蒽环类药物及烷化剂。在此之后,符合条件的患者会接受自体造血干细胞移植巩固治疗,随后进行维持治疗。对于不符合自体造血干细胞移植条件的患者,异基因造血干细胞移植被视为一种可行的替代方案。鉴于找到完全匹配人类白细胞抗原供体存在挑战,单倍体相合造血干细胞移植作为一种潜在的挽救性治疗方法,正如所呈现的临床病例所示。本文介绍了一名50多岁被诊断为浆细胞白血病的女性患者的病例,该患者在自体造血干细胞动员失败后,接受了来自其儿子的单倍体相合造血干细胞移植,结果实现了完全供体嵌合且反应良好。

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