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目的探讨乳腺癌治疗相关急性早幼粒细胞白血病(t-APL)可能的发病机制、临床及实验室特征、治疗及预后。方法对1例乳腺癌化疗后继发的急性早幼粒细胞白血病(t-APL)的病史特点、临床表现、血象、形态学、免疫学、遗传学、分子生物学(MICM)等相关检查、治疗及预后进行分析,并结合文献复习展开讨论。结果包括环磷酰胺及吡柔比星在内的化疗药物是本例t-APL的发病原因;临床表现以贫血、出血、感染及浸润症状为主;血常规三系降低,骨髓涂片见异常早幼粒细胞明显增生;流式细胞学检测提示粒系幼稚细胞比例异常增高,主要表达早期粒系相关抗原;FISH检测证实存在PML/RAR融合基因;PCR分型检测为PML/RAR长型阳性;染色体核型分析存在15号染色体和17号染色体易位,未见其他复杂核型;该患者给予维A酸及三氧化二砷双诱导治疗后复查骨髓涂片提示CR。结论 t-APL的发病可能与细胞毒性化疗药物的应用相关;t-APL与APL的临床及实验室特征相似,MICM仍然是t-APL分层诊断的重要手段;维A酸及三氧化二砷是t-APL的有效治疗药物。
Objective To investigate the possible pathogenesis, clinical and laboratory characteristics, treatment and prognosis of breast cancer associated acute promyelocytic leukemia (t-APL). Methods The clinical features, clinical manifestations, hemogram, morphology, immunology, genetics, molecular biology (MICM) and other related tests and treatment of 1 case of acute promyelocytic leukemia (t-APL) And prognosis analysis, combined with literature review to discuss. Results The chemotherapeutic drugs, including cyclophosphamide and pirarubicin, were the cause of t-APL in this case. The main clinical manifestations were anemia, hemorrhage, infection and infiltration. The thrombocytopenia was abnormal in the third trimester of blood Proliferation of promyelocytic granuloma cells were detected by flow cytometry. The proportion of immature granulocyte lineages was abnormally increased, which was mainly expressed in early stage of granulocyte-associated antigen. FISH assay confirmed the presence of PML / RAR fusion gene. PCR typing was positive for PML / RAR ; Chromosome karyotype analysis of chromosome 15 and chromosome 17 translocation, and no other complex karyotype; the patient given methotrexate and arsenic trioxide double induction therapy review of bone marrow smear prompted CR. Conclusions The incidence of t-APL may be related to the application of cytotoxic chemotherapeutic drugs. The clinical and laboratory characteristics of t-APL and APL are similar, and MICM is still an important method for the stratification diagnosis of t-APL. Vitamin A and arsenic trioxide are the major components of t- APL effective treatment drugs.