急性混合细胞白血病独特临床生物学特征及预后研究

Immunological Characteristics and Prognosis of Hybrid Acute Leukemia

目的:分析急性混合细胞白血病(HAL)独特的临床生物学特征及预后。方法:采用流式细胞术(FCM)分析白血病细胞的免疫表型,最终确诊56例HAL患者,对其骨髓标本进行细胞形态学及相关细胞化学染色分析,以确定其FAB分型,用聚合酶链反应检测骨髓细胞DNA IgH及TCRγ基因重排,采用兼顾急性髓细胞性白血病(AML)和急性淋巴细胞白血病(ALL)的方案治疗,同时结合多项临床生物学指标分析其转归和预后。结果:确诊的HAL其FAB分型以AML-M1/M2、ALL为主;其免疫分型以B系和髓系混合表达多见。CD34在HAL中呈高表达并且是对患者预后具有影响力的因素(P=0.03)。确诊的56例HAL患者中,28例出现IgH基因单克隆重排阳性(50.76%),22例出现TCRγ基因单克隆重排阳性(39.65%),其中2例IgH和TCRγ基因单克隆重排同时出现阳性。此类患者对治疗反应差、缓解率低为36%。结论:HAL属特殊类型白血病,有其独特的临床生物学特征,对化疗方案不敏感,预后较差。

Objective： To analyze the immunological features and prognosis of hybrid acute leukemia（HAL）.Methods： 56 patients with HAL were diagnosed according to the results of morphology,cytochemistry and immuno-phenotyping of bone marrow cells.PCR was used to study IgH and TCRγ genes rearrangements by bone marrowDNA.The therapeutic protocol was made for both AML and ALL.Results： in the 56 patients,the main FAB sub-types were AML-M1/M2 and ALL.B-Ly＋/My＋ phenotype was more frequent.The rate of CD34 antigen expressionwas high in HAL.And it had strong effect on prognosis（P=0.03）.IgH gene rearrangements were found in 28 pa-tients（50.76%）,and TCRγ gene rearrangements in 22 patients（39.65%）.2 patients were found positive simultane-ity.The 56 patients got the low complete remission（36%） and bad effect of therapy.Conclusion： HAL belongs toa kind of specific leukemia,which has the distinct characteristics.The patients with HAL have bad therapeutic ef-fect and prognosis.