慢性粒－单核细胞白血病——附16例分析

Chronicmyelomonocyticleukemia:ananalysisof16cases

为重新全面认识慢性粒－单核细胞白血病（ＣＭＭＬ）特征。对１６例ＣＭＭＬ患者的临床和实验室资料进行分析。结果：ＣＭＭＬ患者起病症状多为非特异性，外周血可出现少量原幼粒、单核细胞，成熟单核细胞比例均＞０．１０，骨髓原始、早幼粒细胞多＞０．０５，原幼单核细胞＞０．０５，成熟单核细胞＞０．２０，伴有明显的二或三系病态造血。表达额外的ＡＤＡ２同工酶。化疗耐受性差。外周血白细胞数和单核细胞数明显升高（分别＞５０×１０９／Ｌ和１０×１０９／Ｌ），骨髓原始及早幼粒细胞与原幼单核细胞＞０．３０者预后很差。结果表明：ＣＭＭＬ是一组异质性疾病，建议将ＣＭＭＬ单独列为一组疾病，从ＭＤＳ中分出来，并将ＣＭＭＬ分为慢性期、加速期和急变期。

Tocharacterizethechronicmyelomonocyticleukemia(CMML),theclinicalandlaborato-rydataof16CMMLpatientswereanalyzed.Therewereafewmyeloblasts,immaturegranulocytes,monoblastsandpromonocytesandmorethan0.10ofmonocytesintheperipheralblood;andmorethan0.05ofmyeloblastsandpromyelocytes,andmorethan0.20ofmonocytesinthebonemarrow(BM).Alpatientshadbi-ortrilineagedyshematopoieses.TheredbloodcelsofaltheexaminedpatientsexpressedextraADA2isozyme.TheprognosiswasverypoorforthepatientswithWBC>50×109/L,monocytes>10×109/L,andthetotalamountofmyeloblasts,promyelocytes,monoblastsandpromonocytesinBMmorethan0.30.TheresultssuggestthatCMMLisaheterogeneousdisorderwhichshouldbeseperatedfromMDS.TheclinicalcoursesofCMMLcanbesubdividedintothreestages:chronicphase,acceleratedphaseandblastcrisis.