系统性红斑狼疮合并多发性骨髓瘤伴持续性全血细胞减少1例并文献复习

Systemic Lupus Erythematosus Complicated by Multiple Myeloma with Persistent Pancytopenia: A Case Report and Literature Review

摘要: 目的：探讨系统性红斑狼疮(systemic lupus erythematosus, SLE)合并多发性骨髓瘤(multiple myeloma, MM)伴持续性全血细胞减少患者的临床特点、可能的发病机制及治疗难点。方法：回顾性分析1例SLE合并MM伴持续性全血细胞减少患者的临床资料，并结合相关文献进行分析总结。结果：患者女性，58岁，SLE病史8年，因全血细胞减少就诊，同时合并肺部感染。完善骨髓形态学示浆细胞占35%，结合其他辅助检查诊断为IgG-κ型MM (Durie-Salmon IIIA期，R-ISS II期)。感染控制后给予减量VCd等方案治疗，3个周期后骨髓浆细胞比例降至4%，提示肿瘤负荷明显下降，但外周血三系恢复不佳，后继续给予促造血及支持治疗。随访1年，患者白细胞及血红蛋白水平部分恢复，但血小板长期低于20 × 10⁹/L，需反复输注血小板。结论：SLE患者血液系统恶性肿瘤发生风险可能增加，在治疗过程中应警惕恶性血液病的发生。SLE与MM均可影响造血功能，其共存时血细胞减少机制复杂。此类患者治疗难度大，需要兼顾多方面综合考量个体化治疗。

Abstract: Objective: To investigate the clinical characteristics, possible pathogenesis, and therapeutic challenges of systemic lupus erythematosus (SLE) complicated by multiple myeloma (MM) with persistent pancytopenia. Methods: A retrospective analysis of clinical data from a patient with SLE complicated by MM and persistent pancytopenia, along with a review of relevant literature. Results: The patient was a 58-year-old woman with an 8-year history of SLE who presented with pancytopenia and concomitant pulmonary infection. Bone marrow morphology revealed that plasma cells accounted for 35% of nucleated cells. Based on additional laboratory and imaging findings, the patient was diagnosed with IgG-κ type MM, classified as Durie-Salmon stage IIIA and R-ISS stage II. After infection was controlled, reduced-dose VCd and other regimens were administered. After three cycle of treatment, the proportion of bone marrow plasma cells decreased to 4%, indicating a significant reduction in tumor burden; however, pancytopenia persisted. Subsequently, supportive therapy and hematopoietic stimulation were given. During 1 year of follow-up, the white blood cell count and hemoglobin level partially recovered, whereas the platelet count remained persistently below 20 × 10⁹/L, requiring repeated platelet transfusions. Conclusion: SLE is associated with an increased risk of hematological malignancies, and the occurrence of malignant hematological diseases should be carefully considered during follow-up and treatment. Both SLE and multiple myeloma can impair hematopoiesis; when they coexist, the mechanisms of cytopenia are complex. Such patients present significant therapeutic challenges and require individualized treatment strategies with comprehensive consideration of multiple clinical factors.