嗜中性粒细胞增多症在多发性骨髓瘤发病

I. Rekhtina, L. Y. Kolosova, V. Khyshova, A. Kovrigina, L. Mendeleeva
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引用次数: 1

摘要

中性粒细胞增多症不是多发性骨髓瘤(MM)所特有的,是排除骨髓增生性肿瘤的一个原因。本文报告1例MM患者发病时伴有嗜中性粒细胞增多(75±109/L),肝脾肿大。检查未发现t(9;22)、BCR/ABL基因和JAK2V617F突变。为了排除MM合并慢性中性粒细胞白血病,我们对CSFR3R基因的临床意义部分进行了研究。缺乏CSFR3R基因突变使得排除慢性中性粒细胞白血病并开始MM治疗成为可能。用硼替佐米、环磷酰胺和地塞米松治疗1个疗程后,患者血液计数恢复正常,肝脏和脾脏大小减小。经过6个疗程的治疗,血液学完全缓解。用环磷酰胺动员外周血干细胞的尝试没有成功。抗骨髓瘤治疗的有效性证明了诊断和治疗策略的正确性。在某些情况下,中性粒细胞增多可以用浆细胞合成粒细胞集落刺激因子的能力来解释。在浆细胞肿瘤存在的情况下,CSFR3R基因的分析可能对MM引起的反应性中性粒细胞增多症以及MM合并慢性中性粒细胞白血病的鉴别诊断具有决定性的意义。
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Neutrophilic hyperleukocytosis in the multiple myeloma onset
Neutrophilic leukocytosis is not specific for multiple myeloma (MM) and is a reason for the exclusion of myeloproliferative neoplasm.A clinical case of MM patient with neutrophilic hyperleukocytosis (75 х 109/L), liver and spleen enlargement at the disease onset is presented. Examination did not reveal t(9;22), BCR/ABL gene and JAK2V617F mutation. To exclude the combination of MM with chronic neutrophilic leukemia, a study of the clinically significant part of the CSFR3R gene was performed. The absence of a CSFR3R gene mutation made it possible to exclude chronic neutrophilic leukemia and start MM treatment. After the 1st therapy course with bortezomib, cyclophosphamide and dexamethasone, blood counts returned to normal, liver and spleen size decreased. After 6 therapy courses, complete hematological remission was achieved. An attempt to mobilize peripheral blood stem cells with cyclophosphamide was unsuccessful. The effectiveness of antimyeloma therapy proved the correctness of the diagnosis and the chosen treatment tactics.Neutrophilic leukocytosis in MM is explained by the ability of plasma cells to synthesize granulocyte colony-stimulating factor in some cases. In the presence of a plasma cell tumor, the analysis of the CSFR3R gene may be of decisive importance in the differential diagnosis of reactive neutrophilic leukocytosis due to MM and the combination of MM with chronic neutrophilic leukemia.
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来源期刊
CiteScore
0.80
自引率
0.00%
发文量
20
审稿时长
12 weeks
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