慢性粒单核细胞白血病的临床特点和预后分析

Clinical characterization and prognostic analysis of chronic myelomonocytic leukemia

目的:本研究探讨慢性粒单核细胞型白血病(CMML)的临床特点及影响其预后的相关因素,评估IPSS、WPSS及MDAPS3个积分系统在CMML预后中的应用意义。方法:选取我院2003年5月-2009年7月CMML病例18例,选取同期急性单核细胞白血病(AML-M5)58例作为对照。结果:CMML伴有明显的多系病态造血。干细胞相关抗原CD34、CD117的表达较低,HLA-DR、CD117、CD14抗原表达均低于AML-M5(P<0.05),CD11b抗原表达高于AML-M5(P<0.05)。结论:WPSS积分系统对CMML的预后评估较为理想;CMML时干细胞相关抗原的表达均较低;CD11b高表达可能与CMML的预后不良有关;常规化疗对CMML的治疗效果不佳,造血干细胞移植是目前惟一有可能治愈CMML的方法。

Objective：The aims of this study were to investigate the clinical characteristics and influencing factors of prognosis of CMML,and assess the prognostic significance of WHO-based Prognostic Scoring System （WPSS）,International Prognostic Scoring System （IPSS）,and M.D. Anderson Prognostic Score （MDAPS）.Method：Eighteen cases with CMML diagnosed according to the criteria of WHO classification were retrospectively analyzed,58 cases with AML-M5 of the same time period were taken as control. All of them were followed up and classified according to IPSS,WPSS and MDAPS risk groups.Result：Dyshaematopoiesis of multiple lineages were observed in CMML patients. The expressions of hemopoietic stem cell related antigens CD34 and CD 117 were relatively low. The expression of HLA-DR,CD117 and CD14 antigens were lower than AML-M5 （P0.005）. The expression of CD11b antigen was higher than AML-M5 （P0.05）.Conclusion：Our single center results proved that WPSS is an effective system to evaluate the prognosis of CMML patients. Stem cell related antigens were all expressed relatively low in CMML. The high expression of CD11b may be associated with the poor prognosis of CMML. Conventional chemotherapies were ineffective in CMML treatment. Hematopoietic stem cell transplantation is the only possible way by now to cure CMML.