38.一位65歲男性,其血液數據顯示,白血球高達160,000/μL,血紅素12..-阿摩線上測驗
38.一位65歲男性,其血液數據顯示,白血球高達160,000/μL,血紅素12.7 g/dL,血小板是165,000/μL,白血球
分類顯示segmented neutrophil 14%,lymphocyte 80.3%,無不成熟血球。其血液抹片之細胞顯示如下圖。 這些淋巴球表達CD19、CD5、dim CD20、CD23、dim kappa light chain restriction。而CD10與CD34均陰 性。以下關於這位病人最可能的疾病之診斷與治療,何者錯誤?
(A)典型的周邊血液抹片常出現basket cells或smudge cells
(B)大多數的病人需要接受高劑量化學治療與異體造血幹細胞移植,以得到長期的存活
(C)有些病人會合併有autoimmune thrombocytopenia或autoimmune hemolytic anemia
(D)此類病人一開始通常無明顯與此病相關的症狀,而是偶然抽血檢驗血球數據時才發現此病
2F 宏爺 國一上 (2019/10/11)
慢性淋巴性白血病好發在60歲以上銀髮族,其發生率逐年上升,台灣每年新增病例數約150~200人,平均年齡約66歲。因為早期症狀不明顯或不具特異性,許多病人健檢時意外發現白血球過高,或是因為淋巴結腫大而求診。 CLL can be diagnosed using the 2018 iwCLL update of the National Cancer Institute guidelines, when both of the following criteria are met: ●Absolute B lymphocyte count in the peripheral blood ≥5000/microL [5 x 109/L], sustained for at least three months, with a preponderant population of morphologically mature-appearing small lymphocytes. ●Clonality of the circulating B lymphocytes should be co... 查看完整內容 慢性淋巴性白血病好發在60歲以上銀髮族,其發生率逐年上升,台灣每年新增病例數約150~200人,平均年齡約66歲。因為早期症狀不明顯或不具特異性,許多病人健檢時意外發現白血球過高,或是因為淋巴結腫大而求診。 CLL can be diagnosed using the 2018 iwCLL update of the National Cancer Institute guidelines, when both of the following criteria are met: ●Absolute B lymphocyte count in the peripheral blood ≥5000/microL [5 x 109/L], sustained for at least three months, with a preponderant population of morphologically mature-appearing small lymphocytes. ●Clonality of the circulating B lymphocytes should be confirmed by flow cytometry of the peripheral blood demonstrating immunoglobulin light chain restriction (kappa or lambda). A majority of the population should express the following pattern of markers: extremely low levels of SmIg and either kappa or lambda (but not both) light chains; expression of B cell associated antigens (CD19, CD20, and CD23); and expression of the T cell associated antigen CD5. (A) Chronic lymphocytic leukemia peripheral blood smear Peripheral blood smear reveals five CLL cells with prominent chromatin clumping (snickerdoodle-like) and two smudge (basket) cells. Wright-Giemsa, 150x magnification. A期病人,雖然不需要接受治療,但因為有淋巴腺腫大或白血球增加的狀況,患者必須定期追蹤觀察; B期病人,通常已出現肝脾腫大,但醫師會視其身體狀況,譬如:年紀多大、是否有其他慢性疾病或是已經合併發生貧血、紫斑等現象,以及患者的經濟能力可否負擔藥物或是藥物是否有健保給付等藥物取得性,再綜合判斷是否要進行治療; C期病人,由於已經影響身體造血功能,一定要接受治療。
已上市的口服小分子標靶藥物,分別是可以讓癌細胞溶解、促使癌細胞凋亡的BCL-2抑制劑 ,以及抑制癌細胞增生的BTK抑制劑 。 BCL-2抑制劑透過細胞正常的凋亡機制,讓癌細胞快速溶解、死亡。根據臨床試驗,10個患者中有6人達到「深層緩解」,也就是「微量殘存疾病」(minimal residual disease,簡稱MRD)陰性,代表患者的血液中幾乎測不到癌細胞,未來復發機率大幅降低,甚至有機會可以停藥。 ref: http://web.tccf.org.tw/lib/addon.php?act=post&id=3787 https://www.commonhealth.com.tw/blog/blogTopic.action?nid=3317 | |
3F
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38.一位65歲男性,其血液數據顯示,白血球高達160,000/μL,血紅素12..-阿摩線上測驗
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