急性红白血病的生物学特征与临床疗效研究

Biological Characteristics and Therapeutic Effect of Acute Erytho-Leukemia

本研究探讨急性红白血病(AML-M6)的生物学特征与临床疗效的关系。对29例M6初治患者细胞形态学、免疫表型和染色体核型进行回顾性分析并观察临床化疗效果,同时随机抽取30例AML-M2(急性粒细胞白血病部分分化型)作为对照。结果表明:M6患者的外周血中均可见幼稚细胞(2%-10%)及有核红细胞,骨髓穿刺细胞学检查显示19例伴有多系细胞发育异常,累及二系细胞或三系细胞。流式细胞术检测表明,M6Gly-A(血型糖蛋白A)的表达率高达(66.67±23.86)%,明显高于其在M1,M2,M3,M4和M5中的阳性表达率(P<0.01)。M6高表达HLA-DR[(60.00±24.79)%],CD34[(40.00±24.79)%],CD38[(33.33±23.86)%],髓系抗原主要表达CD13[(66.67±23.86)%],MPO[(33.33±23.86)%],CD33[(46.67±25.25)%],CD15[(33.33±23.86)%],CD117[(46.67±25.25)%]。部分病例伴有淋系抗原的表达,如CD3、CD4、CD19,其中CD4的表达高达26.67%。M6中CD38、CD33、CD15、MPO的阳性表达率低于M2患者。9例M6患者染色体的检查显示,4例存在核型异常,异常率达44.44%,其中复杂核型异常1例。M6患者化疗完全缓解率为29.41%,低于M2患者化疗完全缓解率(68.18%,P<0.01)。结论:Gly-A是鉴别M6与其他亚型急性髓性白血病的一个重要标志,M6有自己独特的生物学表型,其化疗效果不佳可能与其生物学特征有关。

The objective of this study was to investigate the biological characteristics and the therapeutic effect in patients with acute erythroleukemia （AML-M6 ）. Morphology, immunophenotype and cytogenetics were retrospectively analyzed in 29 patients with AML-M6 and were compared with 30 AML-M2 patients. The results showed that there were immature cells （2% - 10% ） and erythroblast, and puncture of bone marrow revealed myelodysplastic features involving multiple hemopoietic lineages in bone marrow of 19 patients. Flow cytometry indicated that the expression frequency of Gly-A in M6 significantly increased （66.67 ± 23.86） % and higher than that in M1, M2 , M3, M4 and M5 （ P 〈 0.01 ）. The expression frequencies of HLA-DR （60.00 ± 24.79% ）, CD34 （40.00 ± 24.79% ）, CD38 （ 33.33 ± 23.86% ） in M6 were high, and the frequencies of myeloid immunophenotypes CD13 （66.67 ± 23. 86% ）, MPO （33.33 ±23. 86% ） , CD33 （46.67±25.25% ） , CD15 （33.33±23.86% ） , CD117 （46.67 ±25.25% ） were common as well in M6. Lymphocytic immunophenotypes CD3, CD4, CD19 were detected in part of patients with M6, and the expression frequencies of CD4 was 26.67%. The expression frequences of CD38, CD33, CD15, MPO in M6 were less common than that in M2 （P 〈0.01 ）. In 4 out of 9 M6 patients the chromosomal abnormatility （44.44%） was seen, in one of which complex chromosome abnormality was found. The complete remmision rate of M6 patients was 29.41%, and lower than that of M2 patients （68.18%, P 〈0.01 ）. It is concluded that Gly-A is a specific immunophenotype in M6, which can help to distinguish M6 from other types of acute myeloid leukemia. Poor clinical therapeutic response may correlated with its biological characteristics.