12例急性混合细胞白血病的诊断与疗效分析

Analysis of twelve patients with hybrid acute leukemia

目的分析急性混合细胞白血病(HAL)的临床和实验室特征以及疗效和预后.方法 根据骨髓细胞形态学、化学染色和免疫表型结果诊断HAL,评价疗效及影响疗效的相关因素.结果 12例HAL临床表现可有发热、淋巴结肿大、脾大、肝大、睾丸浸润等,所有患者骨髓增生明显活跃,近半数患者属高白细胞白血病.进行免疫表型检测者11例,B-Ly+/My+双表型8例、T-Ly+/My+双表型2例、B+T-Ly+/My+型1例.诱导化疗的总CR率64%,6例以兼顾粒、淋二系的方案治疗后全部CR,有4例巩固强化治疗后持续缓解,平均无病生存已19(16～24)个月.结论 HAL属特殊类型的白血病,其诊断有赖于对细胞形态学、化学染色和免疫分型的综合判断.对HAL的治疗应该给予兼顾粒、淋二系的诱导和巩固化疗方案.但长期疗效的评价还有待进一步观察.

Objective To analyze the clinlcal and laboratorial features of hybrid acute leukemia （HAL）, as well as the effect of chemotherapy and the prognosis of HAL. Methods HAL was diagnosed according to the results of morphology, cytochemistry and immunophenotyping of bone marrow cells, and the outcomes and associated factors were valued. Results Clinical presentation of twelve HAL patients ipcluded fever, enlargement of lymph node, spleen and/or liver, and infiltration of testis. Marrows of all the patients were markedly hypercellular. Almost half patients were hyper-leukocytic leukemias. Of the eleven patients whose immunophenotypes were examined, 8 were B-Ly^＋/My^＋ phenotype, 2 were T-Ly^＋/My^＋ phenotype and one was B-TLy^＋/My^＋ phenotype. The overall complete remission （CR） with induction chemotherapy were 64 percent . 6 patients all reached CR with the regimen involved both myeloid and lymphoid lineage, 4 of these six CR patients remained constant CR following consolidation and intensification chemotherapies and the duration of event free survival were 19 months （range from 16 to 24 months）. Conclusion HAL belongs to one kind of specific leukemia, which diagnosis depends on the overall analysis of cell morphology, cytochemistry and immunophenotyping. Modality of chemotherapy for HAL should give attention to both ALL and AML. Further study is needed to elucidate the longterm prognosis of HAL.