白血病的系列变异和转换(附8例报告)

Lineage heterogeneity and lineage switch in leukemia——A clinical analysis of eight cases

近年来,白血病的系列变异和系列转换受到重视。本文分析了我院1982年5月至1987年6月白血病系列变异和系列转换8例,结合文献复习对其发病率、临床特点、发病机理、治疗及预后等问题进行了讨论。

Lineage heterogeneity and lineage switch were found in eight cases of CML and acute leukemia. Three cases with lineage heterogeneity manifested as acute mixecd lineage leukemia, e. i. coexppression of lymoid and myeloid features at diagnosis. Three cases of CML had the features of lineage switch and provided a further example of lineage heterogeneity. These three cases had an apoarent conversion or switch: one of them switched to acute myelocytic leukemia in the first blast crisis and reswitched to acute lymphocytic leukemia a few months later, while other two cases switched to acute histiocytic leukemia after blast crisis. Lineage switch was also found in acute leukemia in two cases: one case with ALL was ansited to acute mixed lymphoid and myeloid leukemia in the course of chemotherapy, another case of acute monocytic leukemia to acute erythroleukemia after two years remission following the treatment with CTX and Arac, TBI and fetal liver transplantation. The therapeutic responses to antileukemic therapy in all cases were unsatisfactory. Six cases died in one to eighteen momths after diagnosis; one case rela psed after half yeal's remission and was still under chemotherapy; another case had complicalion of the central nervous system leukemia after eight months' remission.