费城染色体阳性急性淋巴细胞白血病伴妊娠诊疗并文献复习
Philadelphia Chromosome-positive Acute Lymphoblastic Leukemia in a Pregnant Woman and Literature Review
姚遥 1雷棋怡 1刘彬 1李晓莉 1吴德沛 1王荧1
作者信息
- 1. 苏州大学附属第一医院血液内科,江苏 苏州 215006
- 折叠
摘要
目的 探讨妊娠期伴费城染色体阳性急性淋巴细胞白血病(Ph+ALL)的临床特征及诊治方法.方法 回归性分析2020年5月苏州大学附属第一医院收治的1 例妊娠中期Ph+ALL患者的诊治经过,并复习相关文献.结果 患者青年女性,2020年5月产检时发现血象异常,至完善骨髓检查诊断为Ph+ALL,中期妊娠状态.予激素联合伊马替尼诱导化疗,至孩子顺利生产.巩固化疗治疗过程中患者出现疾病复发,予Hyper-CVAD B方案再诱导达CR,并行CART巩固治疗,患者骨髓库无全合供体,与其父亲HLA配型半相合,移植前体检排除禁忌证,行父供女单倍体造血干细胞移植.截止目前时间,患者疾病仍持续缓解中.结论 妊娠期伴Ph+ALL的治疗难度高,患者容易复发,除传统化疗外,酪氨酸激酶抑制剂、CAR-T及异基因造血干细胞移植等治疗方法可能进一步提高疗效.
Abstract
Objective To investigate the clinical characteristics and treatment methods of pregnancy with Philadelphia chromosome-positive acute lymphoblastic leukemia(Ph+ALL).Methods A retrospective analysis of the diagnosis and treatment process of a mid-term pregnant patient with Ph+ALL treated at the First Affiliated Hospital of Soochow University in May 2020,and a review of relevant literature.Results The patient,a young woman,was found to have abnormal blood counts during prenatal examination in May 2020.She was diagnosed with Ph+ALL in mid-term pregnancy after further bone marrow examination.She was treated with steroid and imatinib induction chemotherapy,and successfully delivered the child.During the consolidation chemotherapy,the patient experienced disease relapse,and was induced to achieve complete remission with the Hyper-CVAD B regimen and received CART consolidation therapy.The patient had no fully matched donor in the bone marrow registry,and her father was found to be a half-matched HLA type,so she underwent a pre-transplant examination and received a single haploidentical hematopoietic stem cell transplantation from her father.As of the present time,the patient's disease is still in continuous remission.Conclusion Pregnancy accompanied by Ph+ALL is highly difficult to treat,and patients are prone to relapse.In addition to traditional chemotherapy,tyrosine kinase inhibitors,CAR-T,and allogeneic hematopoietic stem cell transplantation may further improve the efficacy of treatment.
关键词
妊娠/急性淋巴细胞白血病/酪氨酸激酶抑制剂/异基因造血干细胞移植Key words
pregnancy/acute lymphoblastic leukemia/tyrosine kinase inhibitors/allogeneic hematopoietic stem cell transplantation引用本文复制引用
基金项目
国家血液病临床研究中心(2020WSC04)
国家血液病临床研究中心(H220559)
出版年
2024
NETL
NSTL
万方数据