急性早幼粒细胞白血病免疫表型特点

Immunophenotypic Analysis of Acute Promyelocytic Leukemia

目的:分析急性早幼粒细胞白血病(acute promyelocytic leukemia,APL)患者骨髓中异常早幼粒细胞的免疫表型,探讨其特点及意义。方法:用4色免疫分型方法对43例APL患者的骨髓有核细胞进行免疫表型分析;用CD45-SSC综合设门法,定义CD45强度位于10~2、SSC强度位于10~2细胞群为R3,CD45强度位于10~3、SSC强度位于10~2为R5,并定义阳性细胞占该细胞群的80%以上为强阳性表达,20%-80%之间为弱阳性表达,<20%为阴性。结果:79.07%病例存在一群异常细胞群(R3),R3细胞群免疫表型特点为SSC偏高,CD45表达强度稍弱,CD38^+、CD9^+和CD13^+均为100%,其中呈强阳性的分别为86.05%、90.70%和86.05%。CD33、CD117及CD64阳性表达率分别为97.67%、95.35%和83.8%,其中强阳性表达率分别为86.05%、69.77%和30.23%。CD15+43.2%,大部分病例的阳性细胞都呈弱表达。约16.28%和6.98%的患者表达CD34和HLA-DR,且表达强度较弱,均在80%以下。异常细胞跨系表达CD2、CD19、CD7的比例分别为27.92%、6.98%和2.32%,强度均集中于20%-80%的低表达范围内。所有的病例均不表达CD11b。20.93%病例存在两群细胞群(R3与R5),其中R3的免疫表型特点与上述一致。R5细胞群免疫表型特点较R3细胞群SSC偏小,CD45荧光强度较强,比正常淋巴细胞稍弱,CD9、CD13、MPO阳性率为100%,且荧光强度强;不表达CD123、CD25、CD22、CD4、CD64与CD14。结论:APL细胞易伴有嗜碱性颗粒增多,与形态学分型中的M3a相对应,并且伴有嗜碱性颗粒增多的APL具有独特的免疫表型特征,APL的典型免疫表型为high SSC,CD13^+CD9^+CD38^+CD33^+CD117^+CD64^+CD11b^-CD34^-HLADR^-。伴有嗜碱性颗粒增多的APL有其独特的免疫表型特点,存在两群异常细胞,一群细胞与上述表型一致,另一群细胞SSC稍小,CD45表达较强,表达CD13、CD9和MPO,不表达CD123、CD25、CD22、CD4、CD64和CD14。多色流式细胞术检测可辅助APL的快速诊断,对分析白血病细胞的分类及提示预后有着重要意义。

Objective:To investigate the immunophenotype of leukemia promyelocytes(LP) in bone marrow of patients with acute promyelocytic leukemia(APL) and to explore their characteristics and significance.Methods:The immunophenotypes of leukemia cells in 43 patients with APL were analyzed by means of 4 color immunophenotypes;the cell population in which CD45 strength localized at 10 and the SSC strength locatized at 10 was defined as R3,the cell population in which CD45 strength localized at 10 and the SSC strength localized at 10 was defined as R5,moreover the ratio of positive cells > 80%was defined as strong positive expression,the ratio of positive cells between 20%-80%was difined as weak positive expression,the ratio of positive cells <20%was difined as negative by gating method of CD45/SSC.Results:There was a abnormal cell population(R3) in 79.07%cases;the immunophenotypes of R3 was cheracteried by high SSC,weaker expression of CD45,the rate of CD38,CD9 and CD13 all was 100%,moreover their bright expression(> 80%) was 86.05%,90.70%and 86.05%,respectively;the positive expression rate of CD33,CD117 and CD64 was 97.67%,95.35%and 83.80%respectively,moreover thier bright expression was84.04%,69.77%and 30.23%respectively;the CD15 was weakly expressed in 39.53%cases,the CD34 and HLADR were weakly expression in 16.28%and 6.98%cases respectively.All the cases did not express CD116.There were2 cell populations(R3 and R5) in 20.93%cases,the immunophenotypic features of R3 were cosistant with above mentioning,while the immunophenotypes of R5 were lower than those of R3 SSC;the fluorescence intensity of CD45 was higher,but lower than that in normal lymphycytes,the positive rate of CD9,CD13,MPO was 100%,moreover thier fluorescence intensity was high;they did not expressed CD123,CD25,CD22,CD4,CD64 and CD14.Thereby it can be concluded that the typical immunophenotypes is characterized by CD13^+ CD9^+ CD38^+ CD33 ^+ CD117^+ CD64 ^+CD11b^- CD34^- HLA-DR^- in APL.There was a special immunophenotype in the APL with basophilic granules.Conclusoin:APL has a characteristic immunophenotypic profile,whose typical immunophenotype is characterized by CD13^+ CD9^+ CD38^+ CD33^+ CD117^+ CD64^+ CD11b^- CD34^-HLA-DR^-.The special immunophenotype exists in the APL with basophilic granules.Flow cytometric immunophenotyping may be a useful for rapid recognition of APL and has significant for prognosis.