急性髓系白血病缓解期骨髓中“ALIP”样结构与纤维增生的相关性分析

Correlation between ALIP-like Cluster and Fibrous Proliferation in Bone Marrow of Patients with Acute Myeloid Leukemia in CR Phase

本研究探讨急性髓系白血病(AML)化疗后缓解期骨髓中幼稚前体细胞异常定位(abnormal location of immature precursor,ALIP)样结构及纤维增生在预后评估中的作用及二者的相关性。观察47例AML患者从初发到复发前或随访终止前不同时间点采集的骨髓切片132张,以终末是否复发分为复发前组及未复发组,比较单位面积内"ALIP"样结构数量和网硬蛋白纤维化强度(reticalin fiber density,RFD)在两组间的差异;用统计学方法分析二者对AML预后评估作用及二者间的相关性。结果表明:复发前组患者缓解期间"ALIP"样结构数量为3.46±2.71簇/mm2,初发时RFD为2.76%±1.50%,均明显高于未复发组(P<0.05),其中"ALIP"样结构>4簇/mm2或RFD>1.68%者复发率分别高达89.5%及95.2%;"ALIP"样结构>4簇/mm2者初发时骨髓RFD为2.47%±2.48%,与"ALIP"样结构≤4簇/mm2者相比无统计学意义(P>0.05);同时"ALIP"样结构数量和对应时间点的骨髓RFD间相关系数r=0.057,亦无统计学差异(P>0.05)。结论:AML患者骨髓"ALIP"样结构及RFD同为AML早期复发的不良预后因素,但二者间并无相关性,表明"ALIP"样结构的形成不依赖于骨髓纤维增生。

This study was purposed to elucidate the prognostic values of ALIP （abnormal location of immature precursors）-like clusters and fibrous proliferation in bone marrow of AML patients in CR phase and the correlation between them.The bone marrow biopsy sections from 47 AML patients during admitting to relapse or till lost follow-up were examined retrospectively.The 47 patients were divided into pre-relapsed group and non-relapsed group according to relapse or not at end of follow-up.The concentration of ALIP-like cluster and reticulin fiber density （RFD） in sections were compared between the two groups respectively,the prognostic value of these two factors and the underlying relationship between them were estimated by statistical analysis.The results showed that ALIP-like cluster was （3.46 ±2.71）/mm2 during CR and RFD was （2.76％ ± 1.50％） in pre-relapsed cases,which both were higher than those in non-relapsed cases （P ＜ 0.05）.Cases with ALIP-like cluster over 4/mm2 or with RFD ＞ 1.68％ showed high relapse rates of 89.5％ or 95.2％ respectively.RFD were （2.47％ ±2.48％） and （2.44％ ±2.23％） in cases with ＞4/mm2 or ≤4/mm2 respectively,there was no statistical significance（P ＞0.05）.Meanwhile,the amount of ALIP-like cluster in CR not related with the paired RFD （r =0.057,P ＞ 0.05）.It is concluded that both ALIP-like cluster in CR and RFD are poor prognostic factors for heralding early relapse.However,ALIP-like cluster and RFD show no correlation,and suggest that forming of ALIP not depends on fibrogenesis.