年10月8日，由北京医学奖励基金会发起，亿帆医药承办的“血液之星”病例演讲大赛总决赛在“中华医学会白血病淋巴瘤血液年会”期间成功举办。
本次大赛旨在通过具体临床病例交流提升血液领域临床诊断、合理用药经验及探讨临床最先进诊疗进展。历经半年，经过全国数十例专业病例的层层选拔，最终共有5位优秀中青年医生脱颖而出，赢取了总决赛的参赛权。
评委寄语
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群情激烈精彩绝伦
作为本次全国决赛的佼佼者，五位选手在决赛舞台的表现可圈可点。无论是演讲的仪态、语音语调，还是幻灯的制作、排版，以及内容的充实、条理，都各有千秋，尽显精英医师的风采。比赛过程精彩纷呈，经过多维度、全方位的评选，最终根据评委的联合评分，大赛决一等奖（一飞冲天奖）1名，二等奖（标新立异奖）2名，三等奖（妙不可言奖）2名。
一飞冲天奖
01
新型化疗方案
治疗初治急性早期前体T淋巴细胞白血病
医院崔巍医师
病例概述：
这是个男性患者，29岁，因“发现右侧颈部肿物1年”就诊，入院查血提示白细胞两系异常，WBC36.08×/L、PLT15×/L；右侧颈部及锁骨上淋巴结肿大（2*3cm）。完善相关辅助检查后发现结果符合临床诊断标准，确诊为：ETP-ALL。病情特点：患者本病高危，伴有髓外的大包块，髓外广泛浸润，本病恶性程度高，肿瘤负荷高，如何能让患者既能有效，又能平稳着陆，治疗方案选择尤为重要。经慎重讨论后治疗方案选择了改良预激方案（DAC+HAAG方案）。化疗顺利结束，颈部包块肉眼可见日渐消减。治疗过程中也无严重并发症发生。治疗结束一个月的时间，进行全套髓内髓外评估，骨髓评估达到形态学CR程度。患者目前仍旧是持续缓解的状态。
标新立异奖
02
打怪升级医路险，斗智斗勇步步高
南京医院刘文洁医师
病例概述：
该患者为女性，46岁，年1月因“胸痛、发热4天”入院，经查骨髓形态学、免疫表型、细胞遗传学、分子生物学结果后，诊断为：Ph阳性B-ALL。经过规范治疗后患者缓解2年左右的时间；年疾病再次复发，幸运入组CAR-T细胞治疗后缓解3年左右的时间；年患者病情转为AML，给予DCAG方案治疗，缓解了2年左右的时间，至今仍用DCAG方案继续巩固治疗。该患者总病程长达7年。
03
地西他滨+HAAG方案治疗
年轻成人初治AML病例分享
医院尹佳医师
病例概述：
女性患者，32岁，因“反复发热一月余”就诊，入院后经完善一系列辅助检查及鉴别诊断后，诊断为：1、伴t(8;21)急性髓系白血病（髓外浸润，高危组）；2、肺部感染：卡肺、曲霉菌；3、肝脏占位：白血病浸润；病情特点：患者为高危组急性髓系白血病，合并肺部感染，肝脏白血病浸润。患者基础条件差，本病危险度高，治疗相关并发症发生率高。治疗策略：继续抗感染、止血治疗同时，地西他滨联合包含蒽环类药物的预激方案诱导化疗（DAC+1/2HAAG方案）。应用地西他滨+半程HAAG方案获得非常好的完全缓解，1疗程巩固后融合基因下降＞3log，髓外病灶清除，治疗后感染得到控制，没有发生严重的治疗相关并发症；这个方案是一个安全有效的诱导治疗方案，我们前瞻性的临床结果也证实了方案的低*性和较高的完全缓解率。
妙不可言奖
04
老年治疗相关AML合并PPM1D突变1例
医院孙艳萍医师
病例概述：
这是名男性患者，63岁，因“发现全血细胞减少10余天”收治入院，骨髓细胞学示急性髓系白血病（M4EO）。完善辅助检查后，诊断为：1、治疗相关急性髓系白血病（AML-M4EO；CBFB-MYH11阳性）；2、右肺小细胞癌（cT2N3M0，IIIB期，局限期）放化疗后右肺门、纵膈、双侧锁骨上淋巴结转移；3、右侧胸腔积液。治疗方案：初始诱导方案：地西他滨+半量CAG方案；诱导缓解疗效。巩固化疗方案：三个周期的地西他滨+半量CAG方案；疗效进一步巩固。病例诊疗特点：1、老年初诊t-AML患者，合并PPM1D突变，对依托泊苷和阿霉素耐药，而阿柔比星与阿霉素无交叉耐药。2、患者为治疗相关的CBFAML，与初诊患者相比，生存期短，预后差。3、诱导治疗选择地西他滨+半量CAG方案取得了较好疗效。4、、包含地西他滨的巩固治疗利于CBFAML微小残留病的清除，最终达到分子学残留阴性。5、维奈克拉联合HMA是不适合强化疗的t-AML患者的治疗选择。6、造血细胞移植是唯一的治愈希望，符合条件的中高危的t-AML患者或MRD阳性的低危t-AML患者应考虑移植。
05
1例伴CSF3RTI突变老年不典型
慢性粒细胞白血病的诊治
医院娄典医师
病例概述：
患者男性，72岁，年1月因“乏力1月余，咳嗽20余天”入院，血常规异常：WBC66.73×/L，PLT67×/L，HGBg/L。经完善相关辅助检查结果及临床鉴别诊断，最终确诊为：1、不典型慢性粒细胞白血病（伴CSF3RTI突变）；2、高血压病2级很高危组；3、2型糖尿病。治疗方案为：1、预处理加用“羟基脲”降白细胞治疗；2、予以DAC-CAG方案化疗；3、支持治疗。疗效评价：1疗程化疗后复查骨髓形态CR；且持续CR状态。2疗程化疗后流式MRD转阴；且持续阴性。3疗程化疗后WT1基因转阴，且持续阴性。
雄关漫道真如铁而今迈步从头越
陈主任对本次大赛做了细高度的总结评价，他表示作为临床医生，病例是最有意思的事情，病例演讲比赛对于中青年医生来说是最能提升自我的路径，在参赛过程中，选手们通过病例回顾、文献检索、病例汇报、演讲技巧及疾病诊疗知识的掌握都有了很大的提升和进步。五位选手的表现都异常精彩并鼓励选手们继续加强沉淀自身，扩大临床诊疗视野。参与这样的学术交流活动，可以使血液科医生能够得到快速、积极的成长，有助于领域的良性发展。陈主任也同时感谢各位专家评委的点评和选手们的积极参与，再次恭喜本次大赛顺利而圆满结束。
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