55例急性早幼粒细胞白血病形态学、细胞免疫学、细胞遗传学及分子生物学(MICM)分型的回顾性分析

Combined Analysis on Morphology, Immunology, Cytogenetics and Molecular Biology (MICM) Classification of 55 Patients with Acute Promyelocytic Leukemia

为了解在已经确诊的急性早幼粒细胞白血病 (APL)患者中骨髓细胞形态学 (M )、细胞免疫学 (I)、细胞遗传学 (C)和分子生物学 (M) 4者即MICM的关系及对临床诊断的指导意义 ,对 5 5例APL患者的MICM分型检测结果进行了回顾性总结分析。结果显示 ,以FAB分型为基础的形态学确诊率可达 96 4 % ;免疫表型检测以CD33和CD13阳性共表达率为最高 ,达 96 4 % ;APL特征性染色体异常检出率为 87.3% ,其中核型为t( 15 ;17) ( q2 2 ;q2 1) 10 0 %易位者 (单纯型 )占 75 % ,其它可累及的染色体有 1,8,9,11,12 ,2 1号 ;PML/RARα基因检测阳性率达96 4 %。但MICM联合检测用于APL诊断的准确率可达 10 0 %。结论 :骨髓细胞形态学观察仍然是APL确诊的基础 ,MICM联合应用可显著提高APL的确诊率 ,减少误诊率 ;MICM联合检测 ,可能为发现APL新的亚型提供线索。

To investigate the value of bone marrow morphology, immunology, cytogenetics and molecular biology (MICM) examination in the diagnosis of acute promyelocytic leukemia (APL) and their relations of each other, the MICM data of 55 APL patients were analyzed retrospectively. The result showed that the accuracy rate of morphological diagnosis based on FAB classification could reach 96.4%; CD33 and CD13 antigen were co expressed the highest in immunophenotyping (CD33 +CD13 + occupied 96.4%); cytogenetic abnormality containing t (15; 17)(q22; 21) accounted for 87.3%, translocation of chromosomes (simple type) of 100% t (15; 17)(q22; 21) occupied 75%, other involved chromosomes included 1,8,9,11,12,21; the positive rate of PML/RARα gene also reached 96.4%; the accuracy rate of APL diagnosis by combining MICM measure was 100%. In conclusion, the bone marrow morphology still remains to be base for diagnosis of APL, but the combined analysis of MICM could obviously enhance the accuracy of dliagnosis for APL. The MICM examination may provide a new approach to find subtype of APL.