免疫分型结合基因重排对成人急性淋巴细胞白血病诊断及预后的判断价值

The value of immune typing and gene rearrangement in diagnosis and prognosis of acute lymphoblastic leukemia

目的 :探讨用免疫分型结合免疫球蛋白重链 (Ig H )及 T细胞受体γ(TCRγ)基因重排对急性淋巴细胞白血病 (AL L )的分型诊断及预后的判断价值。方法 :免疫分型采用碱性磷酸酶抗碱性磷酸酶复合物 (APAAP)免疫组化法 ,基因重排采用多聚酶链反应技术 (PCR法 )检测 5 8例初治成人 AL L 患者。结果 :1通过免疫分型检测 ,5 8例 AL L 中 ,43例 (74.1% )为不带髓系相关标记的 AL L(My- AL L) ,15例 (2 5 .9% )为带髓系相关标记的AL L(My+ AL L) ,以 CD1 5 最常见。 2采用 PCR法检测 Ig H基因重排和 TCR 基因重排发现 ,5 8例 AL L 中有79.3% (4 6 /5 8)免疫分型与基因重排结果完全吻合 ,即 T- AL L 出现 TCR 基因重排阳性 ,B- AL L 出现 Ig H基因重排阳性 ,2 0 .7% (12 /5 8)基因重排结果与免疫分型不能完全吻合。 3 5 8例 AL L经 DOL P或 DOCP方案 1个疗程后 ,My- AL L CR为 72 .1% (31/43) ,My+ AL L为 6 6 .7% (10 /15 ) ;AL L不同阶段 CR率分别是 :T- AL L为82 .4% (14/17) ,Pro B- AL L为 5 0 .0 % (3/6 ) ,C- AL L为 90 .5 % (19/2 1) ,Pre B- AL L为 33.3% (4 /12 ) ,成熟 B- AL L为 5 0 .0 % (1/2 ) ;经基因重排检测与免疫分型吻合的 AL L CR率为 71.7% (33/46 ) ,不吻合的 AL L 为 6 6 .7% (8/12 )。

Objective:To analyze the typing diagnosis and prognosis of acute lymphoblastic lekemia (ALL) by immune typing (IT) binding immunoglobulin heavy chain (IgH) and T cell receptor γ(TCRγ) gene rearrangement (GA). Method:58 cases of de nove adult ALL were detected by alkaline phosphatase antialkaline phosphatase compound (APAAP) immunohistochemistry and polymerase chain reaction (PCR).Result:① It was detected in all 58 patients,43( 74.1 %) cases didn′t express myeloid associated markers (My -ALL), 15( 25.9 %) expressing them (My +ALL).Among the markers,CD15 + was the most often expressed.② The detection of IgH and TCR showed that GA in 79.3 % (46/58) cases were complete accordance with IT,that was,T ALL were positive in TCR,B All in IgH,but GA in 20.7 % (12/58) cases didn′t completely coincide with IT.③After one course of treatment of ALL cases by DOLP/DOCP,the complete remission rate (CR) of My -ALL was 71.3 % (31/43) and My +ALL was 66.7 % (10/15).The CR of different stages of ALL were 82.4 % (14/17,T ALL), 50.0 % (3/6,proB ALL), 90.5 % (13/21,C ALL), 33.3 % (4/12,pre B ALL) and 50.0 % (1/2,mature B ALL) respectively.CR was 71.7 % (33/46) in cases of ALL whose IT were in accordance with GA,but CR in cases whose IT didn′t coincide with GA was 66.7 % (8/12).Conclusion:In regard to the typing of leukemia,IT should be added on the basis of FAB typing,which might improve the positive rate of diagnosis and have value in prognosis.GA was only a reference in diagnosis,yet it had no guiding significance in prognosis.