慢性粒细胞白血病加速期及急变期的形态学与免疫学分型的相关研究

Correlation research of morphology and immunological typing in acceleration phase and blastic phase of chronic myelogenous leukemia

目的探讨慢性粒细胞白血病(CML)加速期及急变期的细胞形态学和免疫学分型特征。方法对73例慢性粒细胞白血病急变期(CML-BP)患者的骨髓标本分别进行光镜细胞形态学及相关细胞化学染色观察,确定其FAB类型;应用流式细胞仪检测免疫学一系列相关抗原。结果 73例CML-BP患者的FAB分型为慢性粒细胞白血病急髓变(CML-AML)44例,急性淋巴细胞白血病(ALL)21例,急性混合细胞白血病(HAL)8例。流式细胞术行免疫表型分析,21例CML向急性淋巴细胞白血病转变(CML-ALL)患者中,其免疫表型B-ALL 19例,T-ALL 2例;且12例含髓系标志。8例CML向急性混合细胞白血病(HAL)转变(CML-HAL)患者中,免疫表型为B+My 6例;T+My 2例。44例CML-AML患者中,15例含T细胞标志,2例含B细胞标志,其他未见跨系表达。73例CML-BP患者中有29例在CML加速期行流式检查,其中16例急变为急性髓细胞白血病(AML),13例急变为非AML(ALL 9例,HAL 4例)。非AML中2例加速期查见髓系原始细胞和前体淋巴细胞同时存在,余9例为髓系原始细胞或伴淋巴细胞标志。结论流式细胞术对CML-BP的方向及鉴别诊断有一定的提示作用。

Objective To explore the characteristics of morphology and immunology in acceleration phase and blastie phase of chronic myelogenous leukemia（CML）. Methods Seventy-three cases of CML-BP bone marrow specimens were respectively conducted the morphology and related cell chemical dyeing observation for determining the FAB type. Flow cytometry was used to detect series immunological related antigens. Results Among 73 cases of FAB typing,there were 44 cases of CML-AML,21 cases of ALL and 8 cases. 21 cases CML-ALL patients In the immunophenotyping by flow cytometry,among 21 cases of CML-ALL, there were 19 cases of B-ALL,2 cases of T-ALL,moreover 12 cases contained myeloid marker. Among 8 cases CML-HAL,the immuno- phenotypes were 6 cases of B＋My and 2 cases of T＋ My. Among 44 cases CML-AML, 15 cases contained T cell marker, and 2cases contained B cell marker,other cases had no cross-lineage expression. Among 73 cases of CML-BP, 29 cases conducted the flow cytometry detection in the acceleration phase,in which 16 cases urgently changed to AML,and 13 cases to non-AML（9 cases of ALL and 4 cases of HAL）. Among non-AML cases,2 cases had the simultaneous existence of myeloid primitive cells and precursor lymphocyte in the acceleration phase and other 9 cases were myeloid primitive cell or accompanied by lymphocyte marker. Conclusion Flow cytometry has a certain implication role for the direction and differentiation diagnosis of CML-BP.