Ankylosing spondylitis complicated with chronic myeloid leukemia: a case report

doi:10.11958/20253670

Abstract

Abstract:

The co-occurrence of ankylosing spondylitis (AS) with hematological malignancies is relatively rare. This article presents a case of AS complicated by chronic myeloid leukemia (CML). The patient responded effectively to the treatment with nilotinib combined with non?steroidal anti?inflammatory drugs. By reviewing clinical data and conducting a literature review, we aim to enhance clinicians’ awareness of AS with concurrent CML, provide reference for the diagnosis and treatment of similar cases, and avoid misdiagnosis and missed diagnosis.

Key words: spondylitis,ankylosing, leukemia,myelogenous,chronic,BCR-ABL positive, diagnosis,differential

CLC Number:

R593.23，R551.3

Figures/Tables 5

References 23

[1]	黄烽, 朱剑, 王玉华, 等. 强直性脊柱炎诊疗规范[J]. 中华内科杂志, 2022, 61(8):893-900.
	HUANG F, ZHU J, WANG Y H, et al. Recommendations for diagnosis and treatment of ankylosing spondylitis[J]. Chin J of Intern Med, 2022, 61(8):893-900. doi:10.3760/cma.j.cn112138-20211226-00913.
[2]	中华医学会血液学分会. 慢性髓性白血病中国诊断与治疗指南(2020年版)[J]. 中华血液学杂志, 2020, 41(5):353-364.
	Chinese Society of Hematology. The guidelines for diagnosis and treatment of chronic myelogenous leukemia in china (2020 edition)[J]. Chin J Hematol, 2020, 41(5):353-364. doi:10.3760/cma.j.issn.0253-2727.2020.05.001.
[3]	VAN DER LINDEN S, VALKENBURG H A, CATS A. Evaluation of diagnostic criteria for ankylosing spondylitis. A proposal for modification of the New York criteria[J]. Arthritis Rheum, 1984, 27(4):361-368. doi:10.1002/art.1780270401.
[4]	魏琴, 曾涵睿, 陈燕玲, 等. 强直性脊柱炎与非强直性脊柱炎腰椎椎体骨髓水肿MRI对照研究[J]. 实用放射学杂志, 2022, 38(9):1504-1507,1524.
	WEI Q, ZENG H R, CHEN Y L, et al. A comparative study on MRI findings of lumbar vertebral body bone marrow edema in ankylosing spondylitis and non-ankylosing spondylitis[J]. J Pract Radiol, 2022, 38(9):1504-1507,1524. doi:10.3969/j.issn.1002-1671.2022.09.026.
[5]	CARANCI F, TEDESCHI E, UGGA L, et al. Magnetic resonance imaging correlates of benign and malignant alterations of the spinal bone marrow[J]. Acta Biomed, 2018, 89(suppl 1):18-33. doi:10.23750/abm.v89i1-S.7008.
[6]	TZIVRAS M, SOUYIOULTZIS S, TSIRANTONAKI M, et al. Chronic granulocytic leukemia in a patient with ankylosing spondylitis and ulcerative colitis:an interesting association[J]. J Clin Gastroenterol, 1997, 25(1):365-366. doi:10.1097/00004836-199707000-00016.
[7]	张瑾. 慢性粒细胞白血病并发强直性脊柱炎1例[J]. 临床血液学杂志, 2005, 18(2):128-128.
	ZHANG J. A case of chronic myeloid leukemia complicated by ankylosing spondylitis[J]. J Clin Hamotol, 2005, 18(2):128-128. doi:10.3969/j.issn.1004-2806.2005.02.026.
[8]	杨华强. 慢性粒细胞白血病并发强直性脊柱炎1例分析[J]. 中国误诊学杂志, 2007, 7(5):1143-1144.
	YANG H Q. A case analysis of chronic myeloid leukemia complicated by ankylosing spondylitis[J]. Chin J Misdiagn, 2007, 7(5):1143-1144. doi:10.3969/j.issn.1009-6647.2007.05.249.
[9]	BEN ABDELGHANI K, EL MENAA M, BEN ABDELGHANI K, et al. Chronic myeloid leukemia and ankylosing spondylitis[J]. Tunis Med, 2012, 90(12):901.
[10]	王金刚, 郭静明, 商安芳, 等. 强直性脊柱炎合并慢性髓性白血病一例[J]. 中华血液学杂志, 2014, 35(11):965.
	WANG J G, GUO J M, SHANG A F, et al. A case report of co-existing ankylosing spondylitis and chronic myeloid leukemia[J]. Chin J Hematol, 2014, 35(11):965. doi:10.3760/cma.j.issn.0253-2727.2014.11.002.
[11]	邓亚楠, 侯丽君, 钟淑萍, 等. 强直性脊柱炎合并恶性血液病5例报告及临床分析[J]. 风湿病与关节炎, 2016, 5(6):37-39.
	DENG Y N, HOU L J, ZHONG S P, et al. A report and clinical analysis of 5 cases of ankylosing spondylitis complicated by hematological malignancies[J]. Rheum Arthritis, 2016, 5(6):37-39. doi:10.3969/j.issn.2095-4174.2016.06.011.
[12]	JU F H, GONG X B, XU T Z, et al. Chronic myeloid leukemia following repeated diagnostic X-ray exposure for the treatment of recurrent spontaneous pneumothorax in a patient with ankylosing spondylitis:A case report and literature review[J]. Oncol Lett, 2017, 14(6):7495-7498. doi:10.3892/ol.2017.7156.
[13]	李宏超, 刘辰婧, 宋慧. 强直性脊柱炎合并慢性粒细胞白血病一例[J]. 骨科临床与研究杂志, 2019, 4(6):375-376.
	LI H C, LIU C J, SONG H. Ankylosing spondylitis complicated by chronic myeloid leukemia:a case report[J]. J Clin Orthop Res, 2019, 4(6):375-376. doi:10.19548/j.2096-269x.2019.06.012.
[14]	刘雅, 周亚欧. 强直性脊柱炎合并慢性粒细胞白血病1例[J]. 中国医师杂志, 2025, 27(6):941-943.
	LIU Y, ZHOU Y O. A case of ankylosing spondylitis associated with Chronic myeloid leukemia[J]. J Chin Physician, 2025, 27(6):941-943. doi:10.3760/cma.j.cn431274-20240415-00649.
[15]	ALEHASHEMI S, WARD M M. Risk of hematologic malignancies in elderly patients with ankylosing spondylitis:a cohort study and systematic review[J]. Mayo Clin Proc, 2023, 98(1):100-110. doi:10.1016/j.mayocp.2022.06.030.
[16]	KUZNETSOVA V, KRISHNAN V, COSTA A, et al. Chronic inflammation deters natural killer cell fitness and cytotoxicity in myeloid leukemia[J]. Blood Adv, 2025, 9(4):759-773. doi:10.1182/bloodadvances.2024014592.
[17]	PEHLIVAN M, SAHIN H H, PEHLIVAN S, et al. Prognostic importance of single-nucleotide polymorphisms in IL-6,IL-10,TGF-β1,IFN-γ,and TNF-α genes in chronic phase chronic myeloid leukemia[J]. Genet Test Mol Biomarkers, 2014, 18(6):403-409. doi:10.1089/gtmb.2014.0011.
[18]	张志强, 王威威, 董腾靖, 等. 强直性脊柱炎患者外周血TLR4、JAK3基因表达与Th17/Treg失衡的关系[J]. 天津医药, 2024, 52(10):1065-1068.
	ZHANG Z Q, WANG W W, DONG T J, et al. The relationship between TLR4,JAK3 gene expression and Th17/Treg imbalance in peripheral blood of patients with ankylosing spondylitis[J]. Tianjin Med J, 2024, 52(10):1065-1068. doi:10.11958/20240195.
[19]	AU W Y, HAWKINS B R, CHENG N, et al. Risk of haematological malignancies in HLA-B27 carriers[J]. Br J Haematol, 2001, 115(2):320-322. doi:10.1046/j.1365-2141.2001.03114.x.
[20]	HELLGREN K, DREYER L, ARKEMA E V, et al. Cancer risk in patients with spondyloarthritis treated with TNF inhibitors:a collaborative study from the ARTIS and DANBIO registers[J]. Ann Rheum Dis, 2017, 76(1):105-111. doi:10.1136/annrheumdis-2016-209270.
[21]	FARINA N, TOMOMLLERI A, BOFFINI N, et al. Secukinumab is not associated with cancer recurrence or progression in patients with spondyloarthritis and history of neoplastic disease[J]. Rheumatol Int, 2024, 44(11):2431-2434. doi:10.1007/s00296-024-05571-y.
[22]	YE X, CASACLANG N, MAHMUD S M. Use of non-steroidal anti-inflammatory drugs and risk of non-Hodgkin lymphoma:a systematic review and meta-analysis[J]. Hematol Oncol, 2015, 33(4):176-186. doi:10.1002/hon.2165.
[23]	HARBRON R W, PASQUAL E. Ionising radiation as a risk factor for lymphoma:a review[J]. J Radiol Prot, 2020, 40(4):151-185. doi:10.1088/1361-6498/abbe37.

文献来源	国家	性别	年龄/ 岁	AS 确诊时间/年	CML 确诊时间/年	HLA-B27	治疗方案	转归
Tzivras等^[6]	希腊	男	59	31	0	-	NSAIDs、羟基脲	WBC正常，脊柱强直，但疼痛减轻
张瑾^[7]	中国	男	38	2	5	+	NSAIDs、羟基脲	WBC正常，腰痛减轻
杨华强^[8]	中国	男	36	2	5	+	NSAIDs、羟基脲	WBC正常，腰痛减轻
Ben Abdelghani等^[9]	突尼斯	男	46	/	0	+	NSAIDs、物理康复	/
王金刚等^[10]	中国	男	23	2	0	/	NSAIDs、一代TKI	WBC正常，腰痛减轻
邓亚楠等^[11]	中国	男	34	5	2	+	NSAIDs、二代TKI	WBC正常，骶髂关节病灶未进展
Ju等^[12]	中国	男	29	2	3	-	一代TKI	WBC正常，腰痛减轻
李宏超等^[13]	中国	男	28	0	0	+	NSAIDs、二代TKI	WBC正常，腰痛减轻
刘雅等^[14]	中国	男	55	30	2	/	NSAIDs、一代TKI	WBC正常，关节肿痛缓解
本例	中国	男	48	0	0	+	NSAIDs、二代TKI	WBC正常，颈腰疼痛减轻

文献来源	国家	性别	年龄/ 岁	AS 确诊时间/年	CML 确诊时间/年	HLA-B27	治疗方案	转归
Tzivras等^[6]	希腊	男	59	31	0	-	NSAIDs、羟基脲	WBC正常，脊柱强直，但疼痛减轻
张瑾^[7]	中国	男	38	2	5	+	NSAIDs、羟基脲	WBC正常，腰痛减轻
杨华强^[8]	中国	男	36	2	5	+	NSAIDs、羟基脲	WBC正常，腰痛减轻
Ben Abdelghani等^[9]	突尼斯	男	46	/	0	+	NSAIDs、物理康复	/
王金刚等^[10]	中国	男	23	2	0	/	NSAIDs、一代TKI	WBC正常，腰痛减轻
邓亚楠等^[11]	中国	男	34	5	2	+	NSAIDs、二代TKI	WBC正常，骶髂关节病灶未进展
Ju等^[12]	中国	男	29	2	3	-	一代TKI	WBC正常，腰痛减轻
李宏超等^[13]	中国	男	28	0	0	+	NSAIDs、二代TKI	WBC正常，腰痛减轻
刘雅等^[14]	中国	男	55	30	2	/	NSAIDs、一代TKI	WBC正常，关节肿痛缓解
本例	中国	男	48	0	0	+	NSAIDs、二代TKI	WBC正常，颈腰疼痛减轻