CAJ | 학술논문

目的分析急性混合细胞白血病(MAL)的临床与生物学特点、治疗及预后.方法 38例MAL患者骨髓标本分别进行细胞形态学及细胞化学染色,确定其FAB类型,运用一组系列相关单抗和流式细胞仪及直接免疫荧光标记技术进行免疫分型,同时采用短期细胞培养胰酶消化吉姆萨显带技术进行染色体核型分析及巢式反转录聚合酶链反应(RT-PCR)法进行融合基凶检测.治疗方案采用急性粒细胞白血病(AML)和急性淋巴细胞白血病(ALL)兼顾疗法.结果全部MAL患者均有相应的急性白血病相关的临床表现.FAB分型:11例(28.9%)形态学怀疑为MAL,但不能确诊.免疫分型:26例(68.4%)髓系与B系抗原共表达;10例(26.3%)髓系、T系抗原共表达;2例(5.3%)B系、T系与髓系抗原共表达.15例染色体核型分析显示,正常染色体8例(53.3%);异常染色体7例(46.7%),其中以Ph染色体较多见,占33.3%(5/15),且免疫分型均为B-M混合;复合染色体2例,且均为T-M混合.1例Ph+MAL患者,融合基因bcr-abl 190(+),其免疫分型为B-M混合.32例接受化疗的MAL患者,完全缓解(CR)者9例,占28.1%.染色体核型异常组疗效与正常组差异有统计学意义(P＜0.05).结论 MAL具有独特的生物学特征,化疗效果不佳,预后明显较差.
목적 분석급성혼합세포백혈병(MAL)적림상여생물학특점、치료급예후.방법 38례MAL환자골수표본분별진행세포형태학급세포화학염색,학정기FAB류형,운용일조계렬상관단항화류식세포의급직접면역형광표기기술진행면역분형,동시채용단기세포배양이매소화길모살현대기술진행염색체핵형분석급소식반전록취합매련반응(RT-PCR)법진행융합기흉검측.치료방안채용급성립세포백혈병(AML)화급성림파세포백혈병(ALL)겸고요법.결과 전부MAL환자균유상응적급성백혈병상관적림상표현.FAB분형:11례(28.9%)형태학부의위MAL,단불능학진.면역분형:26례(68.4%)수계여B계항원공표체;10례(26.3%)수계、T계항원공표체;2례(5.3%)B계、T계여수계항원공표체.15례염색체핵형분석현시,정상염색체8례(53.3%);이상염색체7례(46.7%),기중이Ph염색체교다견,점33.3%(5/15),차면역분형균위B-M혼합;복합염색체2례,차균위T-M혼합.1례Ph+MAL환자,융합기인bcr-abl 190(+),기면역분형위B-M혼합.32례접수화료적MAL환자,완전완해(CR)자9례,점28.1%.염색체핵형이상조료효여정상조차이유통계학의의(P＜0.05).결론 MAL구유독특적생물학특정,화료효과불가,예후명현교차.
Objective To analyze the clinical and biological features of mixed acute leukemia(MAL).Methods Bone marrow specimens of 38 MAL patients were evaluated to prove the diagnosis and the classification by morphoiogic,immunologic examinations.These patients were treated with protocols suitable for both acute myeloid leukemia(AML)and acute lymphoblastic leukemia(ALL).Results All MAL patients had a leukemia syndrome.Morphologically,the subtypes of M1,M2 and M5 were predominant in AML,as L2 Was in ALL.Immunologically,coexpression of myeloid and B lineage associated antigens was predominant,about 68.4%;cytogenetically,Ph chromosome was observed in 33.3%(5/15)of MAL patients,and immunophenotype was B-M;1 Ph chromosome(+)MAL patient,fusion gene bcr-abl 190(+)and immunophenotype was B-M.In 38 cases,32 patients received chemotherapy.The complete remission rate was 28.1%(9/32).CR of.normal karyotype was significantly higher than that of abnormal ones.Conclusion Patients with MAL have unique biological features and the complete remission rate was low and the prognosis was poor.