摘要
目的探讨乳腺癌治疗相关性急性白血病(t-AL)的发病特点、治疗及预后。方法报道并分析2009—2014年南方医院收治的9例乳腺癌t-AL患者的临床资料,并进行相关文献复习。结果 9例患者使用了蒽环类药物,8例使用了环磷酰胺,5例接受过放疗,9例患者均使用过重组人粒细胞集落刺激因子;中位潜伏期为23个月;7例治疗后继发急性髓系白血病(t-AML)和2例治疗后继发急性淋巴细胞白血病(t-ALL);发现11q23、21q22、t(8;21)、t(15;17)等染色体平衡异位,发现AML1/ETO(+)、PML/RARα(+)、MLL(+)分子遗传学异常。8例患者接受化疗,3例患者行造血干细胞移植(HSCT)。9例患者的中位总生存时间为32个月,3年生存率为44.4%;7例患者获得完全缓解,中位无疾病生存时间为31个月;2例HSCT成功患者中位总生存时间为44个月,3年生存率为100.0%。结论乳腺癌患者接受烷化剂、蒽环类药物化疗以及放疗可发生t-AL,且以t-AML为主,常合并多种细胞遗传学及分子遗传学异常;t-AL治疗以化疗为主,HSCT治疗可改善患者预后;t-AL患者预后较差。
Objective To explore the clinical characteristics,treatment and prognosis of patients with breast cancer t-AL. Methods Reported 9 cases of breast cancer t-AL and conducted a literatures review. Results 9 patients had used anthracyclines,8 cases had used cyclophosphamide,and 5 patients had received radiotherapy. All patients had used granulocyte colony- stimulating factor. The median incubation period was 23 months. There were 7 cases of therapy- related acute myeloid leukemia（ t-AML） and 2 cases of therapy- related acute lymphoblastic leukemia（ t-ALL）. Balanced traslocations like 11q23,21q22,t（ 8; 21） and t（ 15; 17） were identified. Molecular cytogenetic abnormalities including AML1 / ETO（ ＋）, PML/ RARα（ ＋） and MLL（ ＋） were found. 8 patients received chemotherapy,and 3 patients underwent hematopoietic stem cell transplantation（ HSCT）. The median survival time of these 9 patients was 32 months,and 3- year- survival rate was 44. 4%. 7patients achieved complete remission,and the median disease- free survival time was 31 months. The median survival time of 2patients who succeeded in transplant was 44 months,and the 3- year- survival rate was 100. 0%. Conclusion The use of anthracyclines,alkylating agents and radiotherapy on breast cancer patients can lead to t-AL which is mainly t-AML and often combined with various kinds of molecular cytogenetic abnormalities. Chemotherapy is the main treatment. HSCT can improve the survival of t-AL. The prognosis of t-AL patients is poor.
出处
《中国全科医学》
CAS
CSCD
北大核心
2016年第6期710-714,共5页
Chinese General Practice
关键词
乳腺肿瘤
放化疗
辅助
急性白血病
Breast neoplasms
Chemoradiotherapy
adjuvant
Acute leukemia
