成人急性淋巴细胞白血病染色体核型与临床疗效及预后的关系

Relationship of adult acute lymphoblastic leukemia kayotype with chemotherapeutic effect and prognosis

目的探讨成人急性淋巴细胞白血病染色体核型与化疗疗效及预后的关系。方法采用G显带常规技术对110例成人急性淋巴细胞白血病患者的核型进行分析。结果110例患者中94例有核型结果，其中异常核型36例（38．2％）；t（9；22）13例（在异常核型中占36．1％），超二倍体3例（8．3％），亚二倍体3例（8．3％），近三倍体2例（5．6％），6q-2例（5．6％），其余异常13例（36．1％）；按MRC及SWOG标准分成1级、2级、3级、4级4组，均给予VDLP方案联合化疗，1级和4级核型组完全缓解率比较差异有统计学意义（P=0．036），2级和4级核型组完全缓解率比较差异有统计学意义（P=0．003）。结论染色体核型分析对成人急性淋巴细胞白血病患者化疗疗效及预后判断有指导意义，预后差组不应选用常规方案诱导治疗，而应选用疗效更好的方案。

Objective To explore the relationship of adult acute lymphoblastic leukemia kayotype with chemotherapeutic effect and prognosis. Methods Conventional cytogenetic technique of G-band was used to analyze in 110 adult acute lymphoblastic leukemia patients. Results Thirty-six cases（38.2% ） with cytogenetic abnormalities were found in 94 patients. The thirteen cases （ 36.1% ） with t （9 ; 22 ） were the most frequently presented in adult acute lymphoblastic leukemia. Three cases （ 8.3% ） of hyperdiploidy, three cases （8.3 % ） of hypodiploidy, two cases （5.6%） of near triploid, two cases （5.6%） of 6q-, and other 13 cases（36.1% ）abnormalities were found. According to MRC and SWOG criteria, the lgrade, 2grade,3grade,and 4grade groups were treated with VDLP schema respectively. There were statistical siguificances among the outcome of the 1 grade and 4 grade（P =0.036） ,2 grade and 4 grade（P =0.003）. Conclusions Cytogenetics is an important chemotherapeutic and prognostic factor to adult acute lymphoblastic leukemia. Conventional chemotherapeutic schema should not be used in adverse group. On the contrary, the better schema should be used.