妊娠合并弥漫大B细胞淋巴瘤和噬血细胞综合征1例并文献复习

A Case of Pregnancy Complicated with Diffuse Large B-Cell Lymphoma and Hemophagocytic Lymphohistiocytosis with Literature Review

摘要: 目的：探讨妊娠合并弥漫大B细胞淋巴瘤、噬血细胞综合征患者的临床管理方法。方法：回顾性分析2024年10月19日青岛大学附属医院收治的1例孕31周1天合并弥漫大B细胞淋巴瘤、噬血细胞综合征患者的临床资料，并复习相关文献，分析诊疗策略。结果：患者经淋巴结穿刺活检明确诊断为淋巴瘤，诊断时患者处于孕晚期、淋巴瘤进展期，于孕33周3天经剖宫产终止妊娠，患者术后症状加重、病情进展，转入血液内科后于术后第9天给予减量R-CHOP方案化疗，化疗后出现噬血细胞综合征，转入重症医学科后给予甲泼尼龙、美罗培南抗炎及对症治疗后病情稳定，术后新生儿经积极救治后康复出院。结论：妊娠合并淋巴瘤、噬血细胞综合征的治疗应该是个体化的，需要综合考虑胎儿、母亲和疾病相关因素的影响，在挽救母体生命的同时减少对胎儿的影响，建立多学科团队有助于疑难病例的临床诊疗。

Abstract: Objective: This study examined clinical management strategies for pregnant patients diagnosed with diffuse large B-cell lymphoma and hemophagocytic lymphohistiocytosis. Methods: A retrospective analysis was conducted on the clinical data of a 31-week-and-1-day pregnant patient diagnosed with DLBCL and HLH upon admission to the Affiliated Hospital of Qingdao University on October 19, 2024. Additionally, a comprehensive review of relevant literature was undertaken to evaluate diagnostic and therapeutic approaches. Results: The patient was diagnosed with lymphoma through a lymph node biopsy in the third trimester, revealing an advanced stage of the disease. Pregnancy termination was performed via cesarean section at 33 weeks and 3 days gestation. Postoperatively, the patient’s condition deteriorated, prompting a transfer to the Hematology Department, where a reduced-dose R-CHOP chemotherapy regimen was initiated on the 9th day post-operation. HLH subsequently developed following chemotherapy. After transfer to the Intensive Care Unit, methylprednisolone and meropenem were administered for anti-inflammatory and symptomatic treatment, stabilizing her condition. The neonate underwent successful treatment and was discharged postoperatively. Conclusion: Tailored treatment strategies are essential in managing pregnancies complicated by DLBCL and HLH. A thorough evaluation of fetal, maternal, and disease-related factors is critical to optimize maternal survival while minimizing fetal risks. The establishment of a multidisciplinary team is beneficial in managing the clinical complexities of such cases.