慢性粒单核细胞白血病合并淋巴/浆细胞肿瘤9例临床分析
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南京医科大学第一附属医院血液科,江苏 南京 210029

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R733.7

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国家自然科学基金(82200151)


Chronic myelomonocytic leukemia patients co - occurrent with lymphoid/plasma cell neoplasms: a clinical analysis of 9 cases
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Department of Hematology, the First Affiliated Hospital of Nanjing Medical University, Nanjing 210029 , China

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    摘要:

    目的:描述慢性粒单核细胞白血病(chronic myelomonocytic leukemia, CMML)合并淋巴/浆细胞肿瘤患者的临床特征及预后情况。方法:回顾性分析2016年1月—2025年8月于南京医科大学第一附属医院就诊的9例合并淋巴/浆细胞肿瘤的CMML(lymphoma/plasma cell neoplasms with CMML, LP-CMML)患者资料,并与年龄匹配的36例原发CMML(de novo CMML, DN-CMML)进行比较。结果:LP-CMML患者中位年龄66(58,76)岁,8例(88.9%)为男性,所有患者均为CMML-1,合并的淋巴/浆细胞肿瘤以弥漫大B细胞淋巴瘤最常见(3例)。LP-CMML与DN-CMML患者在基本临床特征、细胞遗传学风险分层及疾病危险分层分布上差异均无统计学意义。按照两种恶性肿瘤发生时序将患者分为治疗相关CMML(therapy related CMML,tCMML)4例,非tCMML5例,tCMML患者较非tCMML更年轻(P=0.016),且以发育异常型为主(P=0.048)。对1例tCMML患者进行动态基因检测显示,其在淋巴系统肿瘤诊断时即存在CMML前驱状态,并在病程中发生克隆演变。生存分析显示,LP-CMML患者中位总生存期(6个月 vs. 40个月,P<0.001)与中位无进展生存期(5个月 vs. 29个月,P<0.001)均显著短于DN-CMML患者,亚组分析示tCMML与非tCMML患者生存无显著差异。结论:LP-CMML患者存在临床异质性且预后不佳。

    Abstract:

    Objective: To describe the clinical characteristics and prognosis of chronic myelomonocytic leukemia (CMML) patients co-occurrent with lymphoid/plasma cell neoplasms (LP-CMML). Methods: We retrospectively identified nine LP-CMML cases who visited the First Affiliated Hospital of Nanjing Medical University between January 2016 and August 2025, and compared their features with de novo CMML(DN-CMML). Results: The median age of LP-CMML patients was 66(58,76) years, with 8(88.9%) being male. All patients were classified as CMML-1. The most common co-existing lymphoid/plasma cell neoplasm was diffuse large B-cell lymphoma(3 cases). No differences were found between LP-CMML and DN-CMML in basic clinical characteristics, cytogenetic risk stratification and disease risk stratification. Based on the sequence of occurrence, 4 patients were classified as therapy-related CMML (tCMML) and 5 as non-tCMML. Compared with the non-tCMML patients, tCMML patients were younger(P=0.016) and the dysplastic phenotype predominance(P=0.048). Dynamic monitoring of one tCMML patient revealed a pre-existing CMML precursor state at the time of lymphoid neoplasm diagnosis, with clonal evolution during the disease course. Survival analysis showed shorter median overall survivals(6 months vs. 40 months,P < 0.001) and median progression free survivals(5 months vs. 29 months,P < 0.001) for LP-CMML than those of DN-CMML. No difference was found in survivals between tCMML and non-tCMML subgroups. Conclusion: LP-CMML indicates clinical heterogeneity and poor survival.

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史仲珣,黄菲,朱华渊,等. 慢性粒单核细胞白血病合并淋巴/浆细胞肿瘤9例临床分析[J]. 南京医科大学学报(自然科学版),2026,46(8):1145-1153

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  • 收稿日期:2025-12-27
  • 最后修改日期:2026-03-10
  • 录用日期:2026-03-18
  • 在线发布日期: 2026-08-07
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