Ph^+急性淋巴细胞白血病与慢性粒细胞白血病急淋变的临床特征分析

Analysis of clinical characters of Ph^+ ALL and lymphoid blast crisis CML

目的比较Ph+急性淋巴细胞白血病(ALL)与慢性粒细胞白血病(CML)急淋变的临床特征。方法回顾性分析Ph+ALL患者24例和CML急淋变患者28例的临床资料,比较两组患者的临床资料、细胞免疫表型分析结果以及临床疗效。结果 CML急淋变组肝肿大和脾脏肿大比例显著高于Ph+ALL组(P<0.05或P<0.01)。CML急淋变组WBC>10×109/L比例显著高于Ph+ALL组(P<0.05)。治疗前两组融合基因拷贝数差异无统计学意义(P>0.05)。16例Ph+ALL患者治疗后达到缓解,Bcr/abl融合基因拷贝数平均(0.4±0.1),10例CML急淋变患者达到血液缓解,Bcr/abl融合基因拷贝数平均(50.1±15.4),两组比较差异有高度统计学意义(P<0.01)。Ph+ALL组CR发生率显著高于CML急淋变组(P<0.05),平均生存率显著长于CML急淋变组(P<0.01)。结论 Ph+ALL与CML急淋变具有不同的临床特征和不同的遗传性特征。Ph+ALL诱导完全缓解后,Ph染色体呈阴性,而CML急淋变诱导缓解后Ph染色体仍然存在。Ph+ALL完全缓解率高于CML急淋变患者,平均生存时间长于CML急淋变患者。

Objective To analyze clinical characters of Ph＋ALL and lymphoid blast crisis CML. Methods Clinical data of 24 cases with Ph＋ALL and 28 cases with lymphoid blast crisis CML were retrospectively analyzed. Clinical data, cell phenotype analysis results and clinical efficacy were compared between two groups. Results Proportions of enlargement of the liver and enlargement of the spleen of lymphoid blast crisis CML group were significantly higher than Ph＋ALL group（P〈0.05 or P〈0.01）. The proportion of WBC10×10°/L of lymphoid blast crisis CML was higher than Ph^＋ALL group（P0.05）. Before treatment, the fusion gene copy number showed no difference between two groups（P〉0.05）. Sixteen cases of Ph^＋ALL patients achieved CR, with Bcr/abl fusion gene copy number average（0.4±0.1）;10 cases of lymphoid blast crisis CML group achieved CR, with Bcr/abl fusion gene copy number average（50.1±15.4）. There was sig nificant difference between two groups（P〈0.01）. The incidence cases of Ph＋ALL patients achieved CR, which was higher than lymphoid blast crisis CML group（P〈0.05）. The average survival rate of Ph＋ALL group was significantly longer than the lymphoid blast crisis CML group（P〈0.01）. Conclusion Ph＋ALL shows different clinical characters and cell phenotype compared with lymphoid blast crisis CML. Ph^＋ALL induced after complete remission, Ph chromosome were negative, but CML after becoming urgent to drench induced ease, Ph chromosome still exists. Ph^＋ALL complete response rate is higher than the CML rush drench patients, and the average survival time is longer than the CML anxious patients