ALK阳性CD30⁺系统性间变性大细胞淋巴瘤 IV期A组1例病例报告

One Case Report of Stage IVA ALK-Positive and CD30-Positive Systemic Anaplastic Large Cell Lymphoma

摘要: 本文报道1例中年女性ALK阳性系统性ALCL IV期A组患者，以持续性腰痛、间断发热为首发临床表现，病灶广泛累及淋巴结、双肺及全身多处骨骼，疾病整体呈难治进展状态。患者先后接受传统CHOP方案化疗、维布妥昔单抗联合化疗等多线抗肿瘤治疗。全程影像学及实验室监测提示患者疾病呈缓解与进展交替状态，末次评估达到部分缓解。结合该病例诊疗经过，检索近5年国内外相关文献，分析ALK阳性ALCL的临床病理特征、诊断要点、一线及挽救性治疗方案选择及预后影响因素，总结该类难治性晚期病例的临床诊疗经验，旨在分享一例罕见高危病例的诊疗经验，并探讨其对当前临床实践的启示。

Abstract: Here, we report a middle-aged female patient diagnosed with stage IVA ALK-positive systemic ALCL. The patient presented with persistent lumbago and intermittent fever as initial symptoms, with extensive lesions involving lymph nodes, bilateral lungs and multiple bones. The disease showed refractory and progressive course. The patient received multiple lines of treatment including conventional CHOP chemotherapy and brentuximab vedotin combined chemotherapy. Imaging and laboratory monitoring showed alternating remission and progression of the disease, and partial remission was achieved in the final evaluation. Combined with the diagnosis and treatment process of this case and recent domestic and foreign literature, we analyzed the clinicopathological features, diagnostic criteria, selection of first-line and salvage treatment regimens, complication management strategies and prognostic factors of ALK-positive ALCL. This study summarized the clinical experience in diagnosis and treatment of such refractory advanced cases, in order to share the diagnostic and therapeutic experience of a rare high-risk case and discuss its implications for current clinical practice.