白血病·淋巴瘤
白血病·淋巴瘤
백혈병·림파류
JOURNAL OF LEUKEMIA & LYMPHOMA
2012年
11期
678-680
,共3页
骨髓增生异常综合征%细胞遗传学%治疗%预后
骨髓增生異常綜閤徵%細胞遺傳學%治療%預後
골수증생이상종합정%세포유전학%치료%예후
Myelodysplastic syndrome%Cytogenetics%Therapy%Prognosis
目的 探讨骨髓增生异常综合征(MDS)细胞遗传学的变化与预后的关系.方法 回顾性分析2005年9月至2009年10月确诊的124例骨髓增生异常综合征患者,男79例,女45例,年龄14～79岁,中位年龄57岁.难治性贫血(RA) 26例,难治性贫血伴铁粒幼细胞增多型(RAS) 13例,难治性贫血伴有多系病态造血(RCMD) 21例,难治性贫血伴有幼稚细胞增多Ⅰ型(RAEB-Ⅰ)29例,难治性贫血伴有幼稚细胞增多Ⅱ型(RAEB-Ⅱ)35例.124例患者应用细胞短期培养法及热处理吉姆萨反带技术,分析20个分裂期细胞,随访至2011年12月,根据患者染色体核型情况,分析MDS各个亚型正常核型组和异常核型组,3年转化成白血病发生率(转白率)及生存率.结果 39例RA、RAS患者中正常核型32例,异常核型7例,核型异常率17.9％,而在85例RCMD、RAEB-Ⅰ、RAEB-Ⅱ患者中,检测出异常核型38例,核型异常率44.4％,较RA、RAS明显增高32例,RA、RAS正常核型有2例3年后转化为白血病,7例异常核型中有1例3年后转化为急性白血病.而在38例RCMD、RAEB-Ⅰ、RAEB-Ⅱ异常核型中,随访3年,有16例转化为白血病,转白率42.1％(16/38),47例正常核型中有13例转化为白血病,转白率为27.6％(13/47),两组比较差异有统计学意义(P＜0.05),RCMD、RAEB-Ⅰ、RAEB-Ⅱ组转白率较RA、RAS明显增高,尤其在核型异常组转白率高达42.1％.结论 MDS伴有异常核型者,转白率高,治疗效果差,宜早期行造血干细胞移植治疗.
目的 探討骨髓增生異常綜閤徵(MDS)細胞遺傳學的變化與預後的關繫.方法 迴顧性分析2005年9月至2009年10月確診的124例骨髓增生異常綜閤徵患者,男79例,女45例,年齡14～79歲,中位年齡57歲.難治性貧血(RA) 26例,難治性貧血伴鐵粒幼細胞增多型(RAS) 13例,難治性貧血伴有多繫病態造血(RCMD) 21例,難治性貧血伴有幼稚細胞增多Ⅰ型(RAEB-Ⅰ)29例,難治性貧血伴有幼稚細胞增多Ⅱ型(RAEB-Ⅱ)35例.124例患者應用細胞短期培養法及熱處理吉姆薩反帶技術,分析20箇分裂期細胞,隨訪至2011年12月,根據患者染色體覈型情況,分析MDS各箇亞型正常覈型組和異常覈型組,3年轉化成白血病髮生率(轉白率)及生存率.結果 39例RA、RAS患者中正常覈型32例,異常覈型7例,覈型異常率17.9％,而在85例RCMD、RAEB-Ⅰ、RAEB-Ⅱ患者中,檢測齣異常覈型38例,覈型異常率44.4％,較RA、RAS明顯增高32例,RA、RAS正常覈型有2例3年後轉化為白血病,7例異常覈型中有1例3年後轉化為急性白血病.而在38例RCMD、RAEB-Ⅰ、RAEB-Ⅱ異常覈型中,隨訪3年,有16例轉化為白血病,轉白率42.1％(16/38),47例正常覈型中有13例轉化為白血病,轉白率為27.6％(13/47),兩組比較差異有統計學意義(P＜0.05),RCMD、RAEB-Ⅰ、RAEB-Ⅱ組轉白率較RA、RAS明顯增高,尤其在覈型異常組轉白率高達42.1％.結論 MDS伴有異常覈型者,轉白率高,治療效果差,宜早期行造血榦細胞移植治療.
목적 탐토골수증생이상종합정(MDS)세포유전학적변화여예후적관계.방법 회고성분석2005년9월지2009년10월학진적124례골수증생이상종합정환자,남79례,녀45례,년령14～79세,중위년령57세.난치성빈혈(RA) 26례,난치성빈혈반철립유세포증다형(RAS) 13례,난치성빈혈반유다계병태조혈(RCMD) 21례,난치성빈혈반유유치세포증다Ⅰ형(RAEB-Ⅰ)29례,난치성빈혈반유유치세포증다Ⅱ형(RAEB-Ⅱ)35례.124례환자응용세포단기배양법급열처리길모살반대기술,분석20개분렬기세포,수방지2011년12월,근거환자염색체핵형정황,분석MDS각개아형정상핵형조화이상핵형조,3년전화성백혈병발생솔(전백솔)급생존솔.결과 39례RA、RAS환자중정상핵형32례,이상핵형7례,핵형이상솔17.9％,이재85례RCMD、RAEB-Ⅰ、RAEB-Ⅱ환자중,검측출이상핵형38례,핵형이상솔44.4％,교RA、RAS명현증고32례,RA、RAS정상핵형유2례3년후전화위백혈병,7례이상핵형중유1례3년후전화위급성백혈병.이재38례RCMD、RAEB-Ⅰ、RAEB-Ⅱ이상핵형중,수방3년,유16례전화위백혈병,전백솔42.1％(16/38),47례정상핵형중유13례전화위백혈병,전백솔위27.6％(13/47),량조비교차이유통계학의의(P＜0.05),RCMD、RAEB-Ⅰ、RAEB-Ⅱ조전백솔교RA、RAS명현증고,우기재핵형이상조전백솔고체42.1％.결론 MDS반유이상핵형자,전백솔고,치료효과차,의조기행조혈간세포이식치료.
Objective To explore the relationship between cytogenetics with therapy and prognosis in myelodysplastic syndrome.Methods 124 cases of myelodysplastic syndrome from September 2005 to October 2009 were reviewed.124 cases contained 79 males and 45 females,aged 14 to 79 years,median age was 57 years old.26 cases were diagnosed as RA,13 cases as RAS,21 cases as RCMD,29 cases as RAEB-Ⅰ,35 cases as RAEB-Ⅱ.According to the karyotype,124 cases were divided into two groups,79 cases of normal karyotype and 45 cases of abnormal karyotype.Patients were followed up for three years in order to analyze the incidence of myelodysplastic syndrome changed into acute leukemia.Results In 39 patients diagnosed as RA and RAS,32 cases were with normal karyotype and 7 cases (17.9 ％) with abnormal karyotype.15 of 32 cases with normal karyotype achieved hematologic remission after treatment while only 1 of 7 cases with abnormal karyotype achieved remission.1 case with abnormal karyotype changed into acute leukemia after 2 years.In 85 patients diagnosed as RCMD,RAEB-Ⅰ and RAEB-Ⅱ.Difference of the lower incidences of RA and RAS changed into acute leukaemia during 3 years in normal karyotype and abnormal karyotype groups was statistically insignificant (P ＜ 0.05).The incidences of RCMD,RAEB-Ⅰ and RAEB-Ⅱ changed into acute leukemia were higher,especially in the abnormal karyotype group with 42.1 ％.Conclusion Myelodysplastic syndromea with abnormal karyotype is associated with poorer efficacy of therapy,higher incidence of changing into acute leukaemia.The patients can take early allogeneic hematopoietic stem cell transplantation to improve the prognosis.
