Diagnosis and treatment of newly diagnosed hematological malignancies with critical COVID-19 and literature review
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摘要: 目的 分析在2022年12月我国疫情防控政策调整后，奥密克戎传播高峰时期初诊恶性血液病(HM)合并危重新型冠状病毒肺炎患者的诊治。方法 回顾性分析苏州大学附属第一医院血液重症监护病房(HCU)收治的8例初诊HM合并危重新型冠状病毒肺炎的临床表现、治疗及预后，结合既往文献总结此类患者的救治经验。结果 8例患者均因呼吸衰竭接受了机械通气，其中4例为有创通气，3例患者接受升压药治疗，3例接受连续性肾脏替代治疗，7例接受诱导化疗，经血液专科治疗结合ICU生命支持后院内生存率为62.5%。结论 初诊HM患者免疫功能低下，在大流行的背景下感染后易进展为重型/危重型新型冠状病毒肺炎，血液专科ICU能充分结合血液专科治疗和高级生命支持提高患者救治成功率。Abstract: Objective To analyze the diagnosis and treatment of newly diagnosed patients with hematological malignancies (HMs) and critical COVID-19 during the peak of Omicron transmission after the adjustment of China's epidemic prevention and control policy in December 2022.Methods A retrospective analysis was conducted on the clinical manifestations, treatment, and prognosis of 8 patients with newly diagnosed HM suffering from critical COVID-19 admitted to the Hematology ICU of the First Affiliated Hospital of Soochow University. The rescue experience for such patients was summarized in combination with previous literature.Results All 8 patients underwent mechanical ventilation due to respiratory failure, including 4 cases of invasive mechanical ventilation. Three patients received vasopressors, 3 underwent continuous renal replacement therapy(CRRT), and 7 received induction chemotherapy. The in-hospital survival rate after treatment of HMs combined with ICU life support was 62.5%.Conclusion Patients with newly diagnosed HM have decreased immune function and are prone to progressing to severe/critical COVID-19 upon infection against the backdrop of the pandemic. The Hematology ICU can effectively improve the survival of this population by fully integrating hematological treatment and advanced life support.
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Key words:
- hematological malignancy /
- COVID-19 /
- Omicron /
- intensive care unit
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表 1 8例初诊HM合并危重新型冠状病毒肺炎患者的基本临床特征
序号 性别 年龄/岁 HM类型 白细胞计数/(×109/L) 血红蛋白水平/(g/L) 血小板计数/(×109/L) CRP /(mg/L) 分期/基因突变 ECOG /分 1 男 32 T-ALL 209.39 125 16 58.90 NOTCH1 4 2 女 20 APL 93.29 88 47 220.77 阴性 4 3 男 54 AML 86.34 90 110 181.00 DNMT3A、FLT3-ITD、NPM1 4 4 男 69 APL 47.75 137 33 70.96 阴性 3 5 女 64 PCL 1.72 57 22 4.89 DSⅢ期B组 3 6 男 79 DLBCL 13.43 76 105 3.82 Ⅳ期A组 4 7 女 44 T-ALL/LBL 47.40 61 14 192.59 未知 4 8 女 80 MM 3.39 58 82 73.76 DSⅢ期B组 4 注：T-ALL：急性T淋巴细胞白血病；APL：急性早幼粒细胞白血病；DLBCL：弥漫大B细胞淋巴瘤；T-ALL/LBL：T淋巴母细胞白血病/淋巴瘤；MM：多发性骨髓瘤。 
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表 2 8例初诊HM合并危重新型冠状病毒肺炎患者的合并症和干预措施
序号 CPIS/分 SOFA/分 APACHEⅡ/分 机械通气 CRRT 血管活性药物 HCU住院天数/d 1 8 10 17 是 是 是 17 2 8 8 22 是 是 是 16 3 8 5 21 是 否 否 40 4 4 5 13 是 否 否 33 5 5 5 14 是 否 否 8 6 5 4 16 是 否 否 7 7 4 8 22 是 是 是 8 8 5 6 27 是 否 否 9 注：CPIS：临床肺部感染评分；SOFA：序贯器官衰竭评分；APACHEⅡ：急性生理与慢性健康评分。
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表 3 8例初诊HM合并危重新型冠状病毒肺炎患者的原发病治疗和转归
序号 原发病 治疗方案 骨髓评估 后续治疗 转归(死亡时间) 1 T-ALL 长春地辛+地塞米松 CR / 死亡(d17) 2 APL 维甲酸+复方黄黛片/亚砷酸+米托蒽醌 未评估 / 死亡(d16) 3 AML 维奈克拉+阿扎胞苷 CR 维奈克拉+阿扎胞苷，HSCT 存活 4 APL 维甲酸+亚砷酸/复方黄黛片 CR 维甲酸+复方黄黛片 存活 5 PCL BiRd+维奈克拉 PR 支持治疗 存活 6 DLBCL CD20单抗+来那度胺+泽布替尼 未评估 来那度胺+泽布替尼 存活 7 T-ALL/LBL 地塞米松 未评估 化疗 存活 8 MM VRD-lite 未评估 / 死亡(d9) 注：死亡时间：HCU的住院时间。
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