慢性淋巴細胞白血病/小淋巴細胞淋巴瘤合并非霍奇金淋巴瘤臨床分析_《華西醫學》

作者：

王譯 , 范方毅 ,  蘇毅 , 孫浩平 , 劉一嵐 , 邱玲 , 帥燕容 , 何光翠 , 付利 , 易海

中國人民解放軍成都軍區總醫院（成都，610083）;

關鍵詞：

慢性淋巴細胞白血病非霍奇金淋巴瘤 Richter’s綜合征治療發病機制

DOI：

10.7507/1002-0179.20130263

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目的　增加對慢性淋巴細胞白血病合并非霍奇金淋巴瘤臨床病例的認識。方法　通過報道2011年11月和2012年7月入住的2例確診為慢性淋巴細胞白血病合并非霍奇金淋巴瘤患者的診治過程，復習文獻，討論其發病機制、治療及預后。結果　該2例患者均予以化療，其中1例淺表淋巴結明顯縮小，骨髓涂片基本恢復正常，病情控制較好；另1例合并癥多、病情惡化快、腫瘤化療效果欠佳，最后因呼吸衰竭死亡。結論　慢性淋巴細胞白血病合并非霍奇金淋巴瘤，治療上應綜合考慮患者年齡、ECOG評分、臨床分期、預后指數等因素，原則上以治療惡性程度更高的非霍奇金淋巴瘤為主，可根據慢性淋巴細胞白血病分期進行觀察、隨訪或積極治療。

引用本文： 王譯,范方毅,蘇毅,孫浩平,劉一嵐,邱玲,帥燕容,何光翠,付利,易海. 慢性淋巴細胞白血病/小淋巴細胞淋巴瘤合并非霍奇金淋巴瘤臨床分析. 華西醫學, 2013, 28(6): 837-839. doi: 10.7507/1002-0179.20130263 復制

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6.	王建祥, 邱錄貴, 沈志祥, 等. 中國慢性淋巴細胞白血病的診斷與治療指南[J]. 中華血液學雜志, 2011, 32(7): 498-501.
7.	Dasanu CA, Alexandrescu DT. Risk for second nonlymphoid neoplasms in chronic lymphocytic leukemia[J]. Med Gen Med, 2007, 9(4): 35.
8.	B RB. Biggar,Anil K.chaturvedi,james J.goedert and Eric A.engels for the HIV/AIDS Cancer match study.AIDS-related Cancer and severity of immunosuppression in persons with AIDS[J]. J Natl Cancer Inst, 2007, 99(12): 962-972.
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10.	Tsimberidou AM, Keating MJ. Richter’s transformation in chronic lymphocytic leukemia[J]. Semin Oncol, 2006, 33(2): 250-256.
11.	Smit LA, Van MF, Langerak AW, et al. Antigen receptors and somatic hypermutation in B-cell chronic lymphocytic leukemia with Richter’s transformation[J]. Hematologica, 2006, 91(7): 903-911.
12.	Hisada M, Biggar RJ, Greene MH, et al. Solid tumors after chronic lymphocytic leukemia[J]. Blood, 2001, 98(6): 1979-1981.
13.	Schöllkopf C, Rosendahl D, Rostgaard K, et al. Risk of second Cancer after chronic lymphocytic leukemia[J]. Int J Cancer, 2007, 121(1): 151-156.
14.	Thornton PD, Bellas C, Santon A, et al. Richter’s transformation of chronic lymphocytic leukemia. The possible role of fludarabine and the Epstein-Barr virus in its pathogenesis[J]. Leuk Res, 2005, 29(4): 389-395.
15.	Callea V, Brugiatelli M, Stelitano C, et al. Incidence of second neoplasia in patients with B-cell chronic lymphocytic leukemia treated with chlorambucil maintenance chemotherapy[J]. Leuk Lymphoma, 2006, 47(11): 2314-2320.

1. 　Tzankov A, Fong D. Hodgkin’s disease variant of Richter’s syndrome clonally related to chronic lymphocytic leukemia arises in ZAP-70 negative mutated CLL[J]. Med Hypotheses, 2006, 66(3): 577-579.
2. 　Nemets A, Ben Dor D, Barry T, et al. Variant richter’s syndrome: a rare case of classical hodgkin’s lymphoma developing in a patient with chronic lymphocytic leukemia treated with fludarabine[J]. Leuk Lymphoma, 2003, 44(12): 2151-2154.
3. 　Tsimberidou AM. OB’rien S,khouri I,et al.clinical outcomes and prognostic factors in patients with richter[J]. s syndrome treated with chemotherapy or chemoimmunotherapy with or without stem-cell transplantation.J Clin Oncol, 2006, 24(15): 2343-2351.
4. 　Tsimberidou AM, Keating MJ. Richter syndrome: biology, incidence, and therapeutic strategies[J]. Cancer, 2005, 103(2): 216-228.
5. 　Tsimberidou AM, O’brien S, Kantarjian HM, et al. Hodgkin transformation of chronic lymphocytic leukemia:the M[J]. Cancer, 2006, 107(6): 1294–1302.
6. 　王建祥, 邱錄貴, 沈志祥, 等. 中國慢性淋巴細胞白血病的診斷與治療指南[J]. 中華血液學雜志, 2011, 32(7): 498-501.
7. 　Dasanu CA, Alexandrescu DT. Risk for second nonlymphoid neoplasms in chronic lymphocytic leukemia[J]. Med Gen Med, 2007, 9(4): 35.
8. 　B RB. Biggar,Anil K.chaturvedi,james J.goedert and Eric A.engels for the HIV/AIDS Cancer match study.AIDS-related Cancer and severity of immunosuppression in persons with AIDS[J]. J Natl Cancer Inst, 2007, 99(12): 962-972.
9. 　Maddocks-Christianson K, Slager SL, Zent CS, et al. Risk factors for development of a second lymphoid malignancy in patients with chronic lymphocytic leukaemia[J]. Br J Haematol, 2007, 139(3): 398-404.
10. 　Tsimberidou AM, Keating MJ. Richter’s transformation in chronic lymphocytic leukemia[J]. Semin Oncol, 2006, 33(2): 250-256.
11. 　Smit LA, Van MF, Langerak AW, et al. Antigen receptors and somatic hypermutation in B-cell chronic lymphocytic leukemia with Richter’s transformation[J]. Hematologica, 2006, 91(7): 903-911.
12. 　Hisada M, Biggar RJ, Greene MH, et al. Solid tumors after chronic lymphocytic leukemia[J]. Blood, 2001, 98(6): 1979-1981.
13. 　Schöllkopf C, Rosendahl D, Rostgaard K, et al. Risk of second Cancer after chronic lymphocytic leukemia[J]. Int J Cancer, 2007, 121(1): 151-156.
14. 　Thornton PD, Bellas C, Santon A, et al. Richter’s transformation of chronic lymphocytic leukemia. The possible role of fludarabine and the Epstein-Barr virus in its pathogenesis[J]. Leuk Res, 2005, 29(4): 389-395.
15. 　Callea V, Brugiatelli M, Stelitano C, et al. Incidence of second neoplasia in patients with B-cell chronic lymphocytic leukemia treated with chlorambucil maintenance chemotherapy[J]. Leuk Lymphoma, 2006, 47(11): 2314-2320.

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慢性淋巴細胞白血病/小淋巴細胞淋巴瘤合并非霍奇金淋巴瘤臨床分析

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慢性淋巴細胞白血病/小淋巴細胞淋巴瘤合并非霍奇金淋巴瘤臨床分析

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