成人急性淋巴细胞白血病MICM分型分析

MICM classifications analysis of adult acute lymphoblastic leukemia

目的:探讨成人急性淋巴细胞白血病(ALL)患者中骨髓细胞形态学(M)、细胞免疫学(I)、细胞遗传学(C)和分子生物学(M)即MICM的关系及其临床意义。方法:采用细胞形态学检查、染色体R带核型分析、流式细胞仪细胞免疫表型检测和套式逆转录聚合酶链反应(RT-PCR)检测bcr/abl融合基因。结果:以FAB分型为基础的形态学诊断L1型27.0%,L2型67.6%,L3型5.4%;免疫表型检测其中B-ALL29例(78.4%),T-ALL3例(8.1%),还有5例患者同时表达髓系和B系,为急性杂合性白血病(HAL),占13.5%;染色体异常患者中,以t(9;22)(q34;q11)(80.0%)频率最高,33例进行了bcr/abl融合基因检测,有10例(30.3%)阳性。结论:在形态学基础上基于免疫表型、细胞遗传学特征及融合基因表达可以对成人ALL进行准确的分型,对患者治疗方案选择及预后的判断均具有临床价值。

Objective：To discuss the value of bone marrow morphology,immunology,cytogenetics and molecular biology（MICM）examination in the diagnosis of adult actue lymphoblastic leukemia（ALL）and their relations of each other.Methods：Slides with Wright stain were examined for cell morphology.Karyotype was analyzed by R-banding technigue.Cell immunophenotype was determined by flow cytometry.The nest RT-PCR was performed to detect bcr/abl fusion gene.Results：To FAB classification based on morphological diagnosis of L1-type 27.0%,L2-type 67.6%,L3-type 5.4%;Detection of immune phenotype in which B-ALL21 cases（78.4%）,T-ALL2 cases（8.1%）,and four cases of patients with myeloid and B-expression system for the hybrid acute leukemia（HAL）,accounting for 13.5%;In patients with chromosomal abnormalities to t（9;22）（q34;q11）（80.0%） the highest frequency,33 patients were bcr/abl fusion gene testing,there are 10 cases（30.3%） positive.Conclusion：Based on the morphological basis,immunophenotype,cytogenetic features and fusion gene expression in adult ALL can be accurately sub-type of patient treatment options and prognosis of all have clinical value.