常见IgH易位与多发性骨髓瘤细胞形态学分析

Relationship between three common IgH translocations and morphological characteristics of bone marrow myeloma cells in multiple myeloma

目的:研究多发性骨髓瘤(MM)3种常见IgH易位与骨髓瘤细胞形态学特征之间的相关性。方法:分析135例伴有t(4;14)、t(11;14)及t(14;16)的初诊MM患者骨髓涂片及外周血涂片中骨髓瘤细胞形态特征及比例。分别按照细胞成熟度及细胞大小的形态特征对浆细胞形态分类。按细胞成熟度分为成熟型(Ⅰ型)、幼稚型(Ⅱ型)、原始型(Ⅲ型)及中间型(Ⅳ型)浆细胞;按细胞大小分为大浆细胞和小浆细胞(又称为淋巴样浆细胞,LP-PC)。然后根据具有各种不同形态特征浆细胞所占比例,将骨髓瘤分为成熟型骨髓瘤(Ⅰ型骨髓瘤)、幼稚型骨髓瘤(Ⅱ型骨髓瘤)、浆母细胞型骨髓瘤(Ⅲ型骨髓瘤)、中间型骨髓瘤(Ⅳ型骨髓瘤),非成熟型骨髓瘤(Ⅱ型+Ⅲ型+Ⅳ型骨髓瘤)。分析3种IgH易位与不同细胞形态学分型及分类之间的关系。结果:t(11;14)患者中Ⅰ型骨髓瘤占53.45%(31/58),多于t(4;14)患者46.55%(27/58)(P<0.05),且t(11;14)中Ⅰ型浆细胞占总浆细胞比例为62.64%,高于t(4;14)患者50.14%(P<0.05)。t(11;14)患者中伴有LP-PC骨髓瘤占70.69%(41/58),显著多于t(4;14)患者6.85%(5/73)(P<0.05)。t(4;14)患者中非成熟型骨髓瘤占63.01%(46/73),显著多于t(11;14)患者46.55%(27/58)(P<0.05)。而t(14;16)患者例数较少(4/135),形态分类均为非成熟型骨髓瘤细胞且均未检出LP-PC。结论:不同的IgH易位与特定的骨髓瘤细胞形态学特征有关。

Objective：To investigate the relationship between three common IgH translocation and morphological characteristics of myeloma cells in multiple myeloma （MM） patients. Method： A total of 135 newly diagnosed MM patients with t（4; 14）, t（11： 14） and t（14; 16） were enrolled in our study. The cell counting and morphological features of cells from bone marrow and peripheral blood were calculated respectively. Plasma cell （PC） were divided into mature （typeⅠ ） PC, immature （typeⅡ） PC, plasmablastie （type Ⅲ ） PC and intermediate （type Ⅳ） according to the morphological maturation morphological classification. Based on the plasma ceils size, PCs were categorized to large PC and small PC （lymphoplasmacytoid cells, LP-PC）. Then, according to the morphological characteristics of PCs with different proportion, the myeloma is grouped into mature myeloma （type i mye loma）, immature myeloma （type Ⅱ myeloma）, plasmablastic myeloma （type Ⅲ myeloma）, intermediate myeloma （type Ⅳ myeloma） and non-mature myeloma （type Ⅱ ＋ ⅢI ＋Ⅳ myeloma）. It was analyzed that the relationship between IgH translocation and morphological characteristics of myeloma cells classification or myeloma classification. Result：The cases of typeI myelomain t（11;14） patients accounted for 53.45% （31/58） and were more than that in t（4;14） patients which was 46. 55% （27/58） （P〈0.05）. The percentage of type Ⅰ PC to total PC int（11;14） patients was 62.64% and was more than that in t（4;14） patients which was 50.14% （P〈0.05）. The t（11;14） patients accompanied with LP PC was 70.68% （41/58） and was higher than that in t（4; 14） patients which was 6.85% （5/73） （P〈0.05）. The incidence of non-mature myeloma was higher in t（4; 14） patients than that in （11;14） patients （46/73 and 27/58 respectively, P〈0.05）. The t（14;16）patients were rare （4/135） and most of them were accompanied with non-mature PC and without LP PC. Conclusion：Different IgH translocation might be associated with specific morphology of myeloma cell.