幼稚前体细胞异常定位结构特点与急性髓系白血病早期复发的相关性分析

Correlation analysis of the characteristics of ALIP with AML relapse

目的：比较骨髓大簇和小簇幼稚前体细胞异常定位（ALIP）结构与急性髓系白血病（AML）复发的相关性。方法：以抽吸-活检-步取材法采集化疗后AML患者骨髓，将涂片原始细胞数〈5％、切片无ALIP结构者视为真正骨髓完全缓解（CR）；涂片原始细胞数〉5％为典型复发。跟踪观察31例缓解后AML患者骨髓切片，直至涂片复发。当骨髓切片小梁旁区或间区检出3～5个幼稚前体细胞聚集在一起视为小簇ALIP，5个以上聚集在一起视为大簇ALIP。分析大簇、小簇ALIP结构的出现与复发的相关性，并比较其差异。结果：31例骨髓涂片及切片CR的患者中，有22例在随访病程中骨髓切片出现ALIP结构，占71％，ALIP结构的出现与复发有明显的相关性（P〈0．05），且大簇ALIP结构与复发的相关性明显高于小簇ALIP结构（P〈0．05）。切片出现大簇ALIP结构的患者（77±35）d后涂片出现典型复发，小簇ALIP结构者经（150±43）d出现典型复发。结论：骨髓切片上出现ALIP结构者多在短期内出现骨髓涂片复发，其检测复发早于涂片，并且大簇ALIP结构较小簇AL—IP更有价值。

Objective：To investigate the relevance of abnormal localization of immature precursors （ALIP） aggregates and ALIP clusters with the relapse of acute myelocytic leukemia （AML）. Method： Samples of bone marrow from AML patients were collected after chemotherapy. The cases with less than 5% blasts in BM smears and without ALIP in bone marrow biopsy are defined as real CR, the cases with more than 5% bone marrow blasts are defined as typical relapse. ALIP aggregates are regarded as more than five immature precursors away from trabeculae in the marrow, while three to five immature precursors is ALIP clusters. We observed ALIP aggregates and ALIP clusters in bone marrow biopsy among 31 AML patients after real CR until relapse. Result：ALIP is observed in 22 patients among 31 AML patients, the incidence is 71%. The occurrence of ALIP is obviouslycorrelated with relapse of AML （P〈0.05）, moreover, the correlation of ALIP aggregates with relapse is more significant than ALIP clusters （P〈0.05）. The cases with ALIP aggregates usually relapse in （77±35） days, while ALIP clusters is （150 ±43） days. Conclusion：ALIP in bone marrow biopsy is earlier than bone marrow smears in detection of relapse, especially ALIP aggregates. The AML patients with ALIP usually relapse in a short period of time.