作者投稿
专家审稿
编辑办公
邮件订阅
RSS
Successful Treatment of A Patient with Chronic Myeloid Leukemia Complicated by Cerebral Hemorrhage Manifesting as Platelet Abnormal Elevation
-
摘要: 血小板升高为慢性粒细胞白血病(chronic myeloid leukemia, CML)患者外周血的罕见表现。本文首次报道1例以血小板异常增高为表现的CML合并脑出血病例。该患者外周血血小板升高, 凝血功能正常, 因脑出血行颅内血肿清除术, 术后出现术区和其他系统出血, 结合骨髓活检及基因检测确诊为CML。予以氟马替尼经空肠管给药后, 患者病情得以控制, 此项治疗尚属国内外首次报道。本文对该患者的诊治过程进行梳理, 以期为临床医师提供警示与借鉴。Abstract: Platelet elevation is a rare manifestation in the peripheral blood of patients with chronic myeloid leukemia (CML). In this paper, we report for the first time a case of CML combined with cerebral hemorrhage manifested by abnormally elevated platelets. The patient had elevated platelets in the peripheral blood, showed normal coagulation function, and underwent intracranial hematoma removal due to cerebral hemorrhage. After the operation, bleeding from the operated area and other systems occurred, and the patient was diagnosed as having accelerated CML after combining bone marrow biopsy and genetic testing. His condition was controlled after administration of flumatinib through a jejunal tube. Based on this patient's experience, the feasibility ofadministering flumatinib via a jejunostomy tube was determined, which is the first report of its kind in China and abroad.This article summarizes the diagnosis and treatment process of this patient, with the aim of providing a warning and reference for clinicians.
-
Key words:
- cerebral hemorrhage /
- platelet elevation /
- chronic myeloid leukemia
作者贡献：张鑫负责论文撰写；张笑、郭毅、冯俊、肖志源、解兆祥、武静、许冬蕊负责提供病例资料及写作思路；魏俊吉、王裕负责写作指导。利益冲突：所有作者均声明不存在利益冲突 -
图 1 骨髓活检病理(HE, ×200)示骨髓组织中造血组织比例明显减少，脂肪组织比例明显增高(A), 造血组织中粒/红系比例明显增高，巨核细胞易见(B)
Figure 1. Pathologic findings of bone marrow biopsy(HE, ×200) show that the proportion of hematopoietic tissue in bone marrow tissue is significantly reduced, and the proportion of adipose tissue is significantly increased(A), and shows that the proportion of granulocyte/erythroid lineage in hematopoietic tissue is significantly increased, and megakaryocytes are easy to be seen(B)
图 2 患者住院期间病情变化与治疗措施
Figure 2. Changes in the patient's condition and treatment measures during hospitalization
-
[1] Mojtahedi H, Yazdanpanah N, Rezaei N. Chronic myeloid leukemia stem cells: targeting therapeutic implications[J]. Stem Cell Res Ther, 2021, 12(1): 603. doi: 10.1186/s13287-021-02659-1 [2] Takahashi N, Sano H, Mochizuki K, et al. Intracranial hemorrhage in a pediatric patient with chronic myeloid leukemia in chronic phase: a case report[J]. Case Rep Oncol, 2021, 14(1): 525-530. doi: 10.1159/000515011 [3] Kouzuki K, Umeda K, Saida S, et al. Sudden intracranial hemorrhage in a patient with atypical chronic myeloid leukemia in chronic phase[J]. J Pediatr Hematol Oncol, 2018, 40(8): e553-e556. doi: 10.1097/MPH.0000000000001061 [4] Oyama C, Arakawa Y, Ikeda Y, et al. Chronic-phase chronic myeloid leukemia with intracranial hemorrhage complicated with tumor lysis syndrome[J]. Rinsho Ketsueki, 2021, 62(5): 346-351. [5] 赵盟, 涂传清, 黄灿, 等. 慢性粒细胞白血病伴脑出血二例并文献复习[J]. 白血病·淋巴瘤, 2019, 28(1): 52-54. doi: 10.3760/cma.j.issn.1009-9921.2019.01.014 Zhao M, Tu C Q, Huang C, et al. Chronic myeloid leukemia with cerebral hemorrhage: report of two cases and review of literature[J]. J Leuk Lymphoma, 2019, 28(1): 52-54. doi: 10.3760/cma.j.issn.1009-9921.2019.01.014 [6] 单秀霞, 孙鹤, 朱西庚. 慢性粒细胞白血病并脑出血一例[J]. 中华血液学杂志, 1990, 11(5): 254. Shan X X, Sun H, Zhu X G. A case of chronic myeloid leukemia with cerebral hemorrhage[J]. Chin J Hematol, 1990, 11(5): 254. [7] Cho S F, Liu T C, Lu C Y, et al. Epidural leukemic involvement and intracranial hemorrhage as initial manifesta-tions in a newly diagnosed chronic myeloid leukemia patient[J]. Ann Hematol, 2011, 90(5): 607-609. doi: 10.1007/s00277-010-1061-7 [8] Muta T, Sawada Y, Moriyama Y, et al. Chronic myeloid leukemia complicated with cerebellar hemorrhage and acute hydrocephalus successfully treated with imatinib and intensive supportive care[J]. Rinsho Ketsueki, 2010, 51(12): 1769-1774. [9] 李胜利. 成功治疗慢性粒细胞白血病伴脑出血1例[J]. 世界最新医学信息文摘, 2013, 13(24): 180. doi: 10.3969/j.issn.1671-3141.2013.24.145 Li S L. Successful treatment of one case of chronic myeloid leukemia with cerebral hemorrhage[J]. World Latest Med Inf, 2013, 13(24): 180. doi: 10.3969/j.issn.1671-3141.2013.24.145 [10] 王谷云, 吴巨峰, 姚红霞. 以脑出血为首发表现的慢性粒细胞白血病1例[J]. 中国误诊学杂志, 2005, 5(9): 1793-1794. Wang G Y, Wu J F, Yao H X. A case of chronic myeloid leukemia with cerebral hemorrhage as the initial manifesta-tion[J]. Chin J Misdiagn, 2005, 5(9): 1793-1794. [11] 袁燕慧, 陈兵, 张启国, 等. 以单纯血小板升高为表现的慢性粒细胞白血病一例报告并文献复习[J]. 中华肿瘤防治杂志, 2016, 23(14): 971-973. Yuan Y H, Chen B, Zhang Q G, et al. A case report and literature review of chronic myeloid leukemia characterized by simple platelet elevation[J]. Chin J Cancer Prev Treat, 2016, 23(14): 971-973. [12] 石耿辉, 化伟利. 以血小板增多为表现的慢性粒细胞白血病1例并文献复习[J]. 中国继续医学教育, 2017, 9(20): 141-143. Shi G H, Hua W L. Chronic granulocytic leukemia presenting with thrombocytosis: a case report and review of the literature[J]. Chin Contin Med Educ, 2017, 9(20): 141-143. [13] 李佳丽, 孔佩艳, 曾东风. 以血小板显著增高为特点的慢性粒细胞白血病三例[J]. 临床内科杂志, 2011, 28(6): 382-383. Li J L, Kong P Y, Zeng D F. Three cases of chronic myeloid leukemia characterized by significant increase in platelets[J]. J Clin Intern Med, 2011, 28(6): 382-383. [14] 段艳芳. 慢性粒细胞白血病伴血小板增多症实施治疗性血细胞单采术1例报告[J]. 齐鲁护理杂志, 2007, 13(1): 102. Duan Y F. A case report of therapeutic blood cell collection surgery for chronic myeloid leukemia with thrombocytosis[J]. J Qilu Nurs, 2007, 13(1): 102. [15] 林凤茹, 王艳, 陈静. bcr-abl基因阳性血小板增多症八例报告: 附文献复习[J]. 中华血液学杂志, 2004, 25(9): 528-531. doi: 10.3760/j:issn:0253-2727.2004.09.004 Lin F R, Wang Y, Chen J. Report of 8 cases of bcr-abl gene positive thrombocytosis and review of the literature[J]. Chin J Hematol, 2004, 25(9): 528-531. doi: 10.3760/j:issn:0253-2727.2004.09.004 [16] 王海洋, 鲍金凤, 袁玖莲. 孤立性血小板增多为首发表现的慢性粒细胞白血病临床特点及实验室检查结果研究[J]. 世界最新医学信息文摘, 2021, 21(77): 23-25. doi: 10.3969/j.issn.1671-3141.2021.77.012 Wang H Y, Bao J F, Yuan J L. Clinical characteristics and laboratory test results of chronic myeloid leukemia with isolated thrombocytosis as the initial manifestation[J]. World Latest Med Inf, 2021, 21(77): 23-25. doi: 10.3969/j.issn.1671-3141.2021.77.012 [17] 彭树弈, 梁晔, 罗琳, 等. 仅以血小板增多为首发表现的慢性粒细胞白血病5例临床分析[J]. 临床血液学杂志, 2015, 28(5): 757-759. Peng S Y, Liang Y, Luo L, et al. Clinical study on 5 cases of chronic myelogenous leukemia with thrombocythemia onset[J]. J Clin Hematol, 2015, 28(5): 757-759. [18] 冯一, 吕娟, 傅佳萍. 孤立性血小板增高慢性粒细胞白血病二例报道[J]. 中华全科医师杂志, 2020, 19(4): 363-365. doi: 10.3760/cma.j.cn114798-20190425-00279 Feng Y, Lyu J, Fu J P. Chronic myeloid leukemia presenting with isolated thrombocytosis: a report of two cases[J]. Chin J Gen Pract, 2020, 19(4): 363-365. doi: 10.3760/cma.j.cn114798-20190425-00279 [19] 冯长伟, 邵燕萍, 任昌明, 等. 以血小板异常增高为特点的慢性粒细胞白血病一例[C]. 造血干细胞移植和细胞免疫治疗高峰论坛暨2016年浙江省血液病学学术年会论文集. 杭州: 浙江省医学会, 2016: 271-272. Feng C W, Shao Y P, Ren C M, et al. A case of chronic myeloid leukemia characterized by abnormal elevation of platelets[C]. Collection of Papers from the Summit Forum on Hematopoietic Stem Cell Transplantation and Cellular Immunotherapy and the 2016 Zhejiang Provincial Hematology Academic Annual Conference. Hangzhou: Zhejiang Medical Association, 2016: 271-272. [20] 袁瑞兰, 常进. 以血小板显著增多为首发表现的慢性粒细胞白血病二例[J]. 白血病·淋巴瘤, 2014, 23(8): 510-511. doi: 10.3760/cma.j.issn.1009-9921.2014.08.019 Yuan R L, Chang J. Two cases of chronic myeloid leukemia with significant increase in platelets as the initial manifesta-tion[J]. J Leuk Lymphoma, 2014, 23(8): 510-511. doi: 10.3760/cma.j.issn.1009-9921.2014.08.019 [21] 刘先桃. 以血小板显著增高为特点的慢性粒细胞白血病一例并文献复习[J]. 内蒙古医学杂志, 2014, 46(9): 1150. Liu X T. A case of chronic myeloid leukemia characterized by significant increase in platelets and literature review[J]. Inner Mongolia Med J, 2014, 46(9): 1150. [22] 王鲁娟, 陈蕾, 刘慧荣, 等. 以血小板显著增高为特点的慢性粒细胞白血病1例[J]. 潍坊医学院学报, 2006, 28(4): 317. Wang L J, Chen L, Liu H R, et al. A case of chronic myeloid leukemia characterized by significant increase in platelets[J]. Acta Acad Med Weifang, 2006, 28(4): 317. [23] 彭树弈. 仅以血小板增多为首发表现的CML5例临床分析[D]. 南宁: 广西医科大学, 2014. Peng S Y. The clinical analysis of five cases with chronic myelogenous leukemia with thrombocythemia onset[D]. Nanning: Guangxi Medical University, 2014. [24] Zhang L, Meng L, Liu B C, et al. Flumatinib versus imatinib for newly diagnosed chronic phase chronic myeloid leukemia: a phase Ⅲ, randomized, open-label, multi-center FESTnd study[J]. Clin Cancer Res, 2021, 27(1): 70-77. [25] 梅赫塔, 帕特尔, 乌雷蒂亚, 等. 伊马替尼的液体剂型: CN201880062828.6[P]. 2020-06-12. Mehta S, Patel V, Uretia M, et al. Liquid dosage form of imatinib: CN201880062828.6[P]. 2020-06-12. [26] 宫爱申, 陈笑艳, 邓泮, 等. 酪氨酸激酶抑制剂抗肿瘤新药氟马替尼在人体内的代谢产物研究[C]. 第九届全国药物和化学异物代谢学术会议论文集. 北京: 中国药理学会, 2009: 150-152. Gong A S, Chen X Y, Deng P, et al. Study on the metabolites of the novel antitumor drug flumatinib, a tyrosine kinase inhibitor, in the human body[C]. Proceedings of the 9th National Conference on Drug and Chemical Foreign Body Metabolism. Beijing: Chinese Pharmacological Society, 2009: 150-152. [27] 杨勇. 匹可硫酸钠及甲磺酸氟马替尼人体药动力学研究[D]. 北京: 中国科学院大学, 2012. Yang Y. Pharmacokinetic study of sodium picosulfate and flumatinib mesylate in human body[D]. Beijing: University of Chinese Academy of Sciences, 2012. [28] 宫爱申. 氟马替尼在慢性粒细胞白血病患者体内的药动学和代谢研究[D]. 北京: 中国科学院大学, 2010. Gong A S. Pharmacokinetic and metabolic studies of flumatinib in patients with chronic myeloid leukemia[D]. Beijing: University of Chinese Academy of Sciences, 2010. [29] Jiang B, Qi J Y, Sun M Y, et al. Pharmacokinetics of single- and multiple-dose flumatinib in patients with chronic phase chronic myeloid leukemia[J]. Front Oncol, 2023, 13: 1101738. -
下载:
点击查看大图
图(3)
计量
- 文章访问数: 95
- HTML全文浏览量: 14
- PDF下载量: 19
- 被引次数: 0
