244例髓细胞白血病FAB分型与WHO分型关系及其意义

Relation and significalnce of FAB classification and WHO classification in 244 cases of myeloid leukemia

目的对244例髓细胞白血病[急性原粒细胞白血病部分分化型(M2b)、急性早幼粒粒细胞白血病(M3)、急性粒-单核细胞白血病伴嗜酸粒细胞增多亚型(M4EO)、慢性粒细胞白血病(CML)]患者血液学及临床特征进行分析。方法以细胞形态学为基础,结合细胞遗传学、分子生物学和分子基因学检查方法检测患者标本。结果细胞形态学特征:M2b异常中幼粒细胞,M3异常早幼粒细胞,M4EO异常嗜酸粒细胞,CML粒系细胞。染色体检测表明:M2b、M3、M4EO、CML分别与各自特异性染色体t(8;21)(q22;q22)、t(15;17)(q22;q21)、inv(16)(p13;q22)、t(9;22)(q34;q11)密切相关。融合基因检测表明:M2b、M3、M4EO、CML分别与融合基因AML1-ETO、PML-RARα、CBFβ-MYH11、BCR-ABL密切相关。结论M2b、M3、M4EO、CML4种白血病患者不论在临床特点上,还是细胞形态学上都有各自一定的特征。4种白血病分别与特定的染色体具有一定的相关性。4种白血病分别与特定融合基因具有一定的相关性。特定的染色体和融合基因可作为白血病的标志物,对白血病的诊断、预后估计、监测治疗和微小残留白血病等方面具有一定的价值。世界卫生组织(WHO)分型有利于白血病的诊断和治疗。

Objective To analyze the hematological and clinical features of 244 cases of myeloid leukemia （ M2b, M3, M4Eo, CML）. Methods Specimens of bone marrow in these patients were analyzed by cytomorphology, cytogenetics and molecular biology. Results The cytomorphological features of bone marrow： abnormal neurtrophilic myelocyte in patients with M2b, abnormal promyelocyte in M3 , abnormal eosinophilic granulocyte in M4Eo and myelocyte in CML. The indication of the test of the chromosome： M2b,M3, M4Eo and CML were closely related to their specfic chromosome t（8 ;21 ） （ q22 ;q22） ,t（ 15 ; 17） （ q22 ;q21 ）,inv（16） （ p13 ;q22） and t（9 ;22） （ q34 ;q11 ）. The indication of the test of fusion gene：M2b,M3, M4Eo and CML were closely related to their specfic fusion gene AML1-ETO, PML-RARot, CBFβ- MYH11 and BCR-ABL. Conclusions The features of the patients with the four subtypes of myeloid leukemia （ M2b, M3, M4Eo, CML） were different on clinical features as well as cytomorphology ,cytogenetics and molecular biology. The four subtypes of myeloid leukemia were closely related to their specific chromosomes. The four subtypes of myeloid leukemia were closely related to their specific fusion genes. The specific chromosome and fusion gene are regarded as marker of leukemia, and helpful in leukemia diagnosis, evaluating prognosis, monitoring of treatment and minima residual leukemia. World Health Organization （WHO） classification is more laelpful in leukemia diagosis and treatment.