41例慢性粒单核细胞白血病患者染色体核型特征和预后分析

Karyotypic analysis and prognosis for 41 patients with chronic myelomonocyUc leukemia

目的分析慢性粒单核细胞白血病（chronic myelomonocytic leukemia，CMML）患者的染色体核型特征，并探讨CMML核型与预后之间的关系。方法收集41例CMML患者的临床和实验室资料，对其核型特征和预后进行分析。结果CMML患者以中老年男性为主，根据世界卫生组织分型诊断为CMML—Ⅰ型的患者17例（41．5％）、CMML-Ⅱ型24例（58．5％）。14例（34％）患者伴有异常核型，其中以＋8最为常见。CMML—Ⅰ型患者中核型异常的患者年龄大于核型正常患者的年龄。CMML-Ⅱ型患者中正常核型者的淋巴细胞绝对值高于异常核型者。有随访资料的29例患者中26例死亡，中位生存期为4个月（1～13个月），正常核型者和异常核型者的中位生存期差异无统计学意义，分别为4．5个月和3．8个月（P=0．408）。CMML—Ⅰ型中异常核型者的中位生存期（3个月）短于正常核型者（17个月）（P＝0．015），但在CMML-lⅠ型患者中两者的中位生存期差异无统计学意义（分别2．9个月和5．8个月，P=0．629）。结论染色体核型异常＋8在CMML中最为常见。核型异常是CMML—Ⅰ型患者的预后不良因素，但在CMML－Ⅱ型患者中核型异常与预后无关。

Objective To analyze cytogenetic features of chronic myelomonocytic leukemia （CMML） patients and explore the relationship between cytogenetic characteristics and prognosis. Methods Clinical and laboratory data of 41 CMML patients were analyzed. Results The majority of CMML patients were middle-aged males. According to WHO classification, 17 （41.5%） patients were diagnosed as CMML-I and 24 （58.5%） were diagnosed as CMML- II . 14 （34%） of CMML patients harbored abnormal karyotypes and ＋8 was the most common. CMML-I patients with abnormal karyotypes were older than those with normal karyotypes. CMML-II patients with normal karyotypes had higher lymphocyte counts than those with abnormal karyotypes. Of 29 patients who had follow-up data, 26 died, with the median survival time being 4 （1-13） months. The median survival of patients with normal and abnormal karyotypes were 4.5 and 3.8 months, respectively （P = 0. 408）. The median survival of CMML-I patients with abnormal karyotypes was shorter than those with normal karyotypes （3 and 17 months, P=0. 015）, but no significant difference was found between the median survival of the two groups of CMML-II patients （2. 9 and 5.8 months, P=0. 629）. Conclusion q：-8 has been the most common abnormal karyotype in CMML patients. The abnormal karyotype can be regarded as an indicator of poor prognosis for CMML-I patients. Regardless of their karyotypes, CMML-II patients have even poorer prognosis.