论文部分内容阅读
目的:探讨慢性淋巴细胞白血病(CLL)并发自身免疫性血细胞减少(AIC)的临床特征、生物学特征、治疗及转归。方法:回顾性分析我院诊断治疗的CLL并发AIC患者的临床特征、生物学特征、治疗方法及转归,并复习相关文献。结果:56例CLL患者中6例(11%)并发AIC,其中5例并发自身免疫性溶血性贫血(AIHA),1例并发纯红细胞再生障碍性贫血。4例在经过化疗后并发AIC,中位时间为7(2~40)个月;2例在初诊时并发AIHA。中位年龄为58.5岁,5例为男性;4例为C期,2例为B期。中位外周血淋巴细胞计数为29.25G/L。经过激素、静脉滴注丙种球蛋白、利妥昔单抗或联合化疗后5例达缓解,其中3例随着原发病CLL的复发又再次并发AIC。1例患者经激素和化疗后Coombs'试验转阴,因CLL进展骨髓衰竭并发鲍曼不动杆菌感染而死亡。随访至2012年7月,2例死亡,2例失访,2例存活。结论:CLL并发AIC与男性、高龄、进展期及高的淋巴细胞计数相关。激素为CLL并发AIC的一线治疗,对于CLL进展期的患者联合化疗(如利妥昔单抗+氟达拉滨+环磷酰胺)效果更好。CLL并发AIC的复发率较高,控制原发病可降低AIC的复发率。
Objective: To investigate the clinical features, biological characteristics, treatment and prognosis of chronic lymphocytic leukemia (CLL) complicated with autoimmune cytopenia (AIC). Methods: The clinical features, biological characteristics, treatment and prognosis of CLL complicated with AIC in our hospital were retrospectively reviewed. Relevant literatures were reviewed. Results: Of the 56 CLL patients, 6 (11%) were complicated with AIC. Five of them were complicated with autoimmune hemolytic anemia (AIHA) and one with pure red cell aplasia. Four patients were complicated by AIC after chemotherapy. The median time was 7 (2-40) months. Two patients had AIHA concurrently on the first visit. The median age was 58.5 years and 5 were men; 4 were C and 2 were B. The median peripheral blood lymphocyte count was 29.25G / L. After hormones, intravenous infusion of gamma globulin, rituximab or combination chemotherapy in 5 cases of remission, of which 3 cases with the recurrence of the primary disease CLL again complicated by AIC. One patient died of the Coombs' test after steroid and chemotherapy, as a result of CLL progression of bone marrow failure and Acinetobacter baumannii infection. Follow-up to July 2012, 2 died, 2 lost and 2 survived. Conclusions: CLL complicated with AIC is associated with male, advanced age, advanced and high lymphocyte counts. Hormone is a first-line treatment for CLL complicated with AIC, and is more effective in patients with advanced CLL in combination with chemotherapy (eg, rituximab + fludarabine + cyclophosphamide). CLL concurrent AIC relapse rate is higher, the control of primary disease can reduce the recurrence rate of AIC.