化疗药物体外诱导白血病细胞凋亡与临床疗效的关系

THE RELATIONSHIP BETWEEN APOPTOSIS OF LEUKEMIC CELLS INDUCED BY CHEMOTHERAPEUTIC DRUGS IN VITRO AND CLINICAL RESPONSE

目的 :探索急性淋巴细胞白血病 (AL L)患者体外化疗药物诱导白血病细胞凋亡在化疗疗效预测中的价值。方法 :应用 Td T介导的脱氧核苷酸切口和末端标记法 (Tunel)、单克隆抗体免疫组化检测等方法研究 2 8例初治 AL L 患者体外化疗药物诱导白血病细胞凋亡、bcl- 2表达与临床化疗疗效的关系。结果 :2 8例 AL L 患者中 ,2 0例获完全缓解 (CR)者 ,bcl- 2表达显著低于 8例未缓解(NR)者 (P<0 .0 5 ) ;CR患者长春新碱 (VCR)、柔红霉素 (DNR)和地塞米松 (DXM)体外诱导白血病细胞凋亡率均高于 NR患者 ,差异有显著性 (P均 <0 .0 5 ) ;体外 VCR、DNR和 DXM3种药诱导白血病细胞的总凋亡率 ,可以作为临床预测 AL L 患者 VDCP方案疗效的定量指标。结论 :体外化疗药物能否有效地诱导白血病细胞凋亡是判断 AL L

Objective:To explore the value of apoptosis induced by chemotherapeutic durgs in vitro in prediction of chemotherapeutic prognosis in the patients with acute lymphoblastic leukemia.Methods:Apoptosis induced by chemotherapeutic drugs in vitro was detected by Tunel assay,and the level of bcl 2 expression was measured by immunohistochemistry.The relationship between apoptosis of leukemic cells in vitro and chemotherapeutic results in vivo was analyzed in 28 patients with acute lymphoblastic leukemia.Results:Apoptotic rate of 20 patients with complete remission (CR) induced by any one of vincristine (VCR),danaubicin (DNR) or dethamethsone (DXM) was higher than apoptotic rate of 8 patients with nor remission (NR).The expression of bcl 2 in the patients with CR was lower than the expression in the patients with NR ( P <0.05).Totol of apoptotic rate induced by VCR,DNR and DXM in vitro could be an quantitive index as to predict clinical response to regimen of VDCP in patients with acute lymphoblastic leukemia.Conclusion:Apoptotic level induced by chemotherapeutic drugs in vitro could be an important index to predict chemotherapeutic sensitivity of the patients with acute lymphoblastic leukemia.