急性混合细胞白血病38例临床研究

Clinical analysis of mixed acute leukemia

目的分析急性混合细胞白血病（MAL）的临床与生物学特点、治疗及预后。方法38例MAL患者骨髓标本分别进行细胞形态学及细胞化学染色，确定其FAB类型，运用一组系列相关单抗和流式细胞仪及直接免疫荧光标记技术进行免疫分型，同时采用短期细胞培养胰酶消化吉姆萨显带技术进行染色体核型分析及巢式反转录聚合酶链反应（RT—PCR）法进行融合基因检测。治疗方案采用急性粒细胞白血病（AML）和急性淋巴细胞白血病（ALL）兼顾疗法。结果全部MAL患者均有相应的急性白血病相关的临床表现。FAB分型：11例（28．9％）形态学怀疑为MAL，但不能确诊。免疫分型：26例（6814％）髓系与B系抗原共表达；10例（26-3％）髓系、T系抗原共表达；2例（5．3％）B系、T系与髓系抗原共表达。15例染色体核型分析显示，正常染色体8例（53.3％）；异常染色体7例（46．7％），其中以Ph染色体较多见，占33-3％（5／15），且免疫分型均为B—M混合；复合染色体2例，且均为T—M混合。1例Ph^＋ MAL患者，融合基因bcr-abl190（＋），其免疫分型为B—M混合。32例接受化疗的MAL患者，完全缓解（CR）者9例，占28．1％。染色体核型异常组疗效与正常组差异有统计学意义（P〈0．05）。结论MAL具有独特的生物学特征，化疗效果不佳，预后明显较差。

Objective To analyze the clinical and biological features of mixed acute leukemia（MAL）. Methods Bone marrow specimens of 38 MAL patients were evaluated to prove the diagnosis and the classification by morphologic, immunologic examinations. These patients were treated with protocols suitable for both acute myeloid leukemia （AML） and acute lymphoblastic leukemia （ALL）. Results All MAL patients had a leukemih syndrome. Morphologically, the subtypes of M1, M2 and M5 were predominant in AML, as L2 was in ALL. Immunologically, coexpression of myeloid and B lineage associated antigens was predominant,about 68.4 %; cytogenetically, Ph chromosome was observed in 33.3 %（5/15） of MAL patients, and immunophenotype was B-M; 1 Ph chromosome （＋） MAL patient, fusion gene bcr-abl 190（＋） and immunophenotype was B-M. In 38 cases, 32 patients received chemotherapy. The complete remission rate was 28.1%（9/32）. CR of normal karyotype was significantly higher than that of abnormal ones. Conclusion Patients with MAL have unique biological features and the complete remission rate was low and the prognosis was poor.