通讯作者: 王敬毅, sdjnwjy@aliyun.com

DOI：10.12201/bmr.202510.00030

A case report with FLT3-ITD mutation and BCR/ABL P210 positive refractory acute myeloid leukemia and review of the literature

• 摘要：目的 提高对难治性急性髓系白血病（Acute myeloid leukemia, AML）诊疗的认识方法 回顾性分析山东中医药大学附属医院2024年5月收治的1例难治性急性髓系白血病行多疗程化疗及靶向治疗最终行异基因造血干细胞移植患者的临床资料，并结合文献进行复习。结果 患者为54岁女性，因咳嗽，发热，结合相关检查综合诊断为急性髓系白血病。治疗过程中出现FLT3-ITD突变和BCR/ABL P210阳性，诱导化疗联合靶向治疗后疾病达骨髓学缓解。单倍体造血干细胞移植后30天疾病达骨髓学缓解，FLT3-ITD突变转阴，且STR植入检测处于完全嵌合状态。结论 难治性AML患者进展迅速，预后差，详实的预后分层是指导难治性AML患者治疗的前提。根据分子和遗传学预后分层应用的化疗联合靶向治疗是减轻肿瘤负荷，创造造血干细胞移植条件的有力手段。对于FLT3-ITD突变的复发、难治的患者，FLT3抑制剂联合维奈克拉双靶向治疗后桥接异基因造血干细胞移植（?allogeneic hematopoietic stem cell transplantation，allo-HSCT）可能改善此类患者的预后。

  关键词： 难治性急性髓系白血病; 预后分层; 靶向治疗; 异基因造血干细胞移植

   

  Abstract: Objective To improve the awareness of the diagnosis and treatment of refractory acute myeloid leukemiaMethods The clinical data of a patient of refractory acute myeloid leukemia admitted to the Affiliated Hospital of Shandong University of Traditional Chinese Medicine in May 2024 and finally underwent allogeneic hematopoietic stem cell transplantation were reviewed in combination with the literature.Results The patient was a 54-year-old female diagnosed with acute myeloid leukemia due to cough, fever and combined with related tests.FLT3-ITD mutation and BCR / ABL P210 positive appeared during treatment, and the disease reached myeloological remission after induction chemotherapy combined with targeted therapy.The disease reached myelogenous remission 30 days after haploid allogeneic HSCT transplantation and had a negative FLT3-ITD mutation，and the STR implantation test showed a complete chimeric state.Conclusions Patients with refractory AML have rapid progress and poor prognosis, and detailed prognosis stratification is the prerequisite for guiding the treatment of patients with refractory AML. According to molecular and genetic prognostic stratification,the applied chemotherapy combined with targeted therapy is a powerful means to reduce the tumor load and create the conditions for hematopoietic stem cell transplantation.

  Key words: refractory acute myeloid leukemia; prognosis stratification; targeted therapy; allogeneic hematopoietic stem cell transplantation

  提交时间：2025-10-19

  版权声明：作者本人独立拥有该论文的版权，预印本系统仅拥有论文的永久保存权利。任何人未经允许不得重复使用。
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• 序号	提交日期	编号	操作
  1	2025-08-24	bmr.202510.00030V1	下载

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