| 谢婷,刘真真,李玉霞,等.地西他滨联合 CAG方案治疗伴 ASXL1/CEBPA基因突变的急性髓系白血病继发血小板异常增高 1例并文献复习[J].安徽医药,2025,29(8):1681-1685. |
| 地西他滨联合 CAG方案治疗伴 ASXL1/CEBPA基因突变的急性髓系白血病继发血小板异常增高 1例并文献复习 |
| Decitabine combined with CAG regimen for acute lmyeloid leukemia with ASXL1/CEBPA gene mutations and secondary thrombocytosis:a case report and literature review |
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| DOI：10.3969/j.issn.1009-6469.2025.08.041 |
| 中文关键词: 急性髓系白血病 基因突变 地西他滨 CAG方案 血小板增高 |
| 英文关键词: Acute myeloid leukemia Gene mutation Decitabine CAG regimen Thrombocytosis |
| 基金项目:山东省自然科学基金青年项目( ZR2021QH001；ZR2020QH001) |
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| 中文摘要: |
| 目的探讨地西他滨( DAC)联合阿糖胞苷 +阿克拉霉素 +重组人粒细胞集落刺激因子( CAG)方案对伴 ASXL1/CEBPA基因突变急性髓系白血病( AML)的治疗价值，并对相关文献进行复习。方法选择 2022年 7月山东第二医科大学附属医 院收治的 1例 57岁女性病人为研究对象，根据病人的血常规、血生化、骨髓细胞形态学、遗传学、免疫学、分子生物学等检查诊断为伴 ASXL1/CEBPA基因突变的急性髓系白血病。 DAC联合 CAG方案成功治疗 ASXL1/CEBPA基因突变的急性髓系白血病，总结诊治过程。结果初次应用 IA(伊达比星 +阿糖胞苷)方案化疗后未缓解，随后调整为 DAC联合 CAG方案治疗， 2个疗程后达完全缓解( CR)，之后进行中剂量阿糖胞苷方案巩固治疗。病人在治疗过程中出现血小板异常增高，计数最高达 1 533×109/L，伴多发静脉血栓，经过干扰素及抗凝处理后血小板下降，血栓消失。结论 DAC联合 CAG方案治疗伴 ASXL1/ CEBPA基因突变急性髓系白血病获得满意疗效，但治疗过程出现血小板异常增高，为国内外首次报道。血小板异常增高考虑地西他滨副作用；临床医生在应用 DAC联合 CAG方案治疗 AML病人时，应密切监测血小板水平，必要时采取相应措施，预防血栓。 |
| 英文摘要: |
| Objective To explore the therapeutic value of decitabine (DAC) combined with the CAG regimen (cytarabine, aclarubi-cin, and recombinant human granulocyte colony-stimulating factor) in treating acute myeloid leukemia (AML) with ASXL1/CEBPA gene mutations and to review relevant literature. Methods A 57-year-old female patient diagnosed with AML and ASXL1/CEBPAgene mutations at the Affiliated Hospital of Shandong Second Medical University in July 2022 was selected. Diagnosis was confirmedvia complete blood count, biochemistry, bone marrow cytology, cytogenetics, immunophenotyping, and molecular testing. The patient re-ceived DAC combined with CAG therapy, and the treatment course was documented.Results Initial IA chemotherapy (idarubicin + cytarabine) failed to induce remission. Switching to DAC-CAG achieved complete remission (CR) after two cycles, followed by consoli-dation with intermediate-dose cytarabine. During treatment, the patient developed marked thrombocytosis (platelets: 1 533× 10./L) withmultiple venous thrombi. Platelet normalization and thrombus resolution occurred after interferon therapy and anticoagulation.Conclu. sions The DAC combined with CAG regimen achieved satisfactory therapeutic effects in the treatment of acute myeloid leukemia withASXL1/CEBPA gene mutations, but abnormal platelet elevation occurred during the treatment process, which was reported for the firsttime both domestically and internationally. Abnormal elevation of platelets may be considered as a side effect of decitabine; Clinicaldoctors should closely monitor platelet levels and take appropriate measures if necessary to prevent thrombosis when using the DACcombined with CAG regimen to treat AML patients. |
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