骨髓病性贫血72例临床分析

骨髓病性贫血是由恶性肿瘤细胞骨髓浸润引起的贫血，是以进行性贫血、消瘦及逐渐加重的骨痛为特点的临床综合征，临床诊断不易。现将我院近5年来（2008—2012年）经骨髓穿刺证实恶性肿瘤骨髓浸润引起的贫血72例患者的临床资料进行分析报告如下。

Caspase-9和CMYC在弥漫性大B细胞淋巴瘤中的表达及与患者病理特征和预后的关系

目的探讨半胱氨酸蛋白酶-9(Caspase-9)和细胞性骨髓细胞瘤病病毒癌基因(CMYC)在弥漫性大B细胞淋巴瘤(DLBCL)组织中的表达及其与患者病理特征和预后的关系。方法选取2017年2月至2020年2月周口市中心医院收治的60例DLBCL患者纳入研究,比较DLBCL肿瘤组织及病灶旁正常组织的Caspase-9、CMYC表达水平,分析Caspase-9、CMYC表达与临床病理特征的关系,比较预后良好和预后不良患者的临床病理特征、Caspase-9、CMYC表达水平,采用二元Logistic回归分析DLBCL患者预后不良的影响因素。结果DLBCL患者肿瘤组织中Caspase-9阳性率为43.33%,明显低于正常组织的80.56%,CMYC阳性率为36.67%,明显高于正常组织的13.88%,差异均有统计学意义(P<0.05);Ann Arbor分期Ⅰ~Ⅱ期、国际预后指数(IPI)评分0~2分患者DLBCL肿瘤组织Caspase-9阳性率明显高于Ⅲ~Ⅳ期和3~4分患者,CMYC阳性率低于Ⅲ~Ⅳ期、3~4分患者,差异均有统计学意义(P<0.05);预后不良患者Ann Arbor分期中Ⅲ~Ⅳ期占比、IPI评分中3~4分占比、CMYC阳性表达占比分别为73.08%、65.38%、69.23%,均高于预后良好组的35.29%、32.35%、11.76%,Caspase-9阳性表达占比为23.08%,低于预后良好组的58.82%,差异均有统计学意义(P<0.05);Ann Arbor分期、IPI评分、Caspase-9、CMYC均为影响DLBCL患者预后不良的独立影响因素(P<0.05),其中Ann Arbor分期Ⅲ~Ⅳ期预后不良风险是Ⅰ~Ⅱ期的9.008倍;IPI评分3~4分预后不良风险是0~2分的10.298倍;Caspase-9表达阳性预后不良风险是阴性的0.622倍;CMYC表达阳性预后不良风险是阴性的19.922倍。结论Caspase-9、CMYC异常表达参与DLBCL的进展,与肿瘤恶性程度有关,且Caspase-9、CMYC异常表达是DLBCL预后不良的独立影响因素,对DLBCL预后具有一定的预测价值,可作为预测DLBCL患者预后的参考指标。

以皮肤肿块为首发临床表现的伴MYC和BCL2重排弥漫性大B细胞淋巴瘤

报告1例以皮肤肿块为首发临床表现的伴细胞性骨髓细胞瘤病病毒癌(MYC)基因和B细胞淋巴瘤因子2(BCL2)基因重排弥漫性大B细胞淋巴瘤。患者女,87岁。左侧眉弓上方皮肤结节1年。皮肤科检查:左眉上方一肤色圆形肿物,隆起于皮肤表面,肿物表面可见浸润性红斑,伴少许渗出,并见结痂、鳞屑,边界清楚。皮损组织病理检查:表皮形态正常,真皮层内大量母细胞样淋巴细胞结节状浸润。免疫组化:母细胞样淋巴细胞CD45、CD79a、B细胞淋巴瘤因子6(BCL6)、细胞周期蛋白D1(cyclin D1)及MYC均(+);CD3、CD2、CD30、细胞角蛋白(CKP)、间变性淋巴瘤激酶(ALK)及Epstein-Barr病毒编码RNA(EBER)均(-)。荧光原位杂交检测:MYC、BCL2及BCL6均重排。诊断:伴MYC和BCL2重排弥漫性大B细胞淋巴瘤。患者未治疗,2个月后死亡。

CMYC和PD-L1表达与DLBCL临床病理特征及预后的关系分析

目的探讨CMYC和PD-L1表达与弥漫大B细胞淋巴瘤(DLBCL)临床病理特征及预后的关系。方法选取DLBCL患者92例,免疫组化法检测CMYC及PD-L1蛋白的表达,分析其与DLBCL临床病理特征的关系。结果92例DLBCL组织中72例CMYC蛋白为阳性,阳性率为78.3%,76例PD-L1蛋白为阳性,阳性率为82.6%;Ann Arbor分期Ⅲ~Ⅳ期、有骨髓侵犯的DLBCL患者CMYC及PD-L1的表达阳性率显著高于Ann Arbor分期Ⅰ~Ⅱ期及无骨髓侵犯者(P均<0.05);预后不良组中CMYC及PD-L1的表达阳性率显著高于预后良好组,且Ann Arbor分期为Ⅲ~Ⅳ的患者占比显著高于预后良好组(P<0.05);Logistic回归分析发现,CMYC阳性、PD-L1阳性及Ann Arbor分期均是DLBCL预后不良的独立危险因素(P<0.05)。结论CMYC及PD-L1蛋白在DLBCL患者中特异性高表达,且是DLBCL患者预后判断的潜在指标,值得临床推广应用。

Shwachman Diamond综合征的剪切位点突变及表型分析

目的分析1例Shwachman Diamond综合征(SDS)病人遗传学改变,探讨其与基因型表型的关系。方法提取1例SDS病儿的外周血全基因组DNA,纯化后经PCR扩增,利用二代测序技术对血液系统相关候选基因的全部编码区和侧翼剪切位点区域进行突变筛查,与人类基因组突变数据库中标准序列比对,寻找可疑突变位点,确定存在SBDS基因突变后,对病儿父母进行相同位点测序并进行一代测序验证。结果病儿15岁出现血常规异常,经骨髓穿刺诊断为骨髓增生异常综合征(MDS),染色体G显带核型分析示46,XX,del20q-,后于16岁出现肾功能异常。二代测序结果显示病儿SBDS基因第2外显子剪切位点纯合突变:c.258+2T>C,为纯合突变,其父母此位点均为杂合突变。此位点突变引起病儿SBDS基因mRNA在第2和第3外显子之间出现剪切错误,导致SBDS序列提前终止。结论本研究发现1例SDS病儿SBDS热点突变合并染色体20q-,为丰富基因型表型关系提供了依据。

Effect of Fufang Danshen Pill on Bone Marrow Stem Mobilization when Myocardial Scathe

Objective：To investigate the effect of Fufang Danshen pill on bone marrow stem mobilization during myocardial scathe. Methods：Rat models with expansionary myocardial disease were established by Pituitrin and Furazolidone. Experimental rats were divided into the contrast group, the myocardial scathe group （MS group）, the myocardial scathe and Fufang Dansben pill group （ MS ＋ FD group） and the myocardial scathe and fluvastatin group （ MS ＋ FT group）. The ratio of CD34^＋ cells was examined at the 1^st, 3^nl and 6^th weekend. Index of heart structure and function including LVESD, LVEDD. LYEF, LVEDP and dp/dtmax were evaluated at the 6^th weekend. The HW/BW index was calculated. Results：In the MS group, the index of HW/BW, LVESD, LVEDD and LVEDP were obviously increased （P 〈 0.01 ） and index of dp/ dtmax and LVEF were obviously decreased （P 〈 0.05 ）. The ratio of CD34^＋ cells was significantly improved at the 1^at weekend and then reduced slowly with no difference from that of the contrast group at the 6th weekend. Compared the MS ＋ FD group and the MS ＋ FT group with the MS group, the index of HW/BW, LYESD, LYEDD and LYEDP of were signifi cantly decreased （ P 〈 0.05 ） and index of dp/dtmax and LVEF were increased （P 〈 0.01 ）. The ratio of CD34^＋ cells was significantly higher at the 1^st, 3^nl and 6^th weekend, but had no statistic meaning at 3^nl and 6^th weekend （P 〉 0.05 ）. Conclusion：Pituitrin and Furazolidone can be used to establish rat models with expansionary myocardial disease. There has bone marrow stem mobilization during the early period of myocardial scathe. Fufang Danshen pill has effect on improving bone marrow stem mobilization, lightening the expansionary degree of heart and protecting the heart function. The effect of Fufang Danshen pill is as same as that of fluvastatin.

Expression of Neuropilin-1 Gene in Bone Marrow Stromal Cells from Patients with Myeloid Leukemia and Normal Individuals

Objective: To investigate the expression of neuropilin-1 (NP-1) gene in bone marrow stromal cells (BMSCs) from myeloid leukemia (AML and CML) and normal individuals. Methods: Mononuclear cells were isolated from bone marrow (BM) of CML (14 cases), AML (12 cases) and normal individuals (20 cases). Adherent cells (i.e. BMSCs) were collected after long-term culture in vitro. The expression of NP-1 gene in three groups was detected respectively by reverse-transcription polymerase chain reaction (RT-PCR). Results: The long-term culture of BMSCs was successfully established. The expression level of NP-1 gene was significantly lower in BMSCs from AML (47.1%) and CML (50%) than in normal individuals (85%). Conclusion: NP-1 gene is expressed in BMSCs from some AML or CML patients and most normal individuals. The low-expression of NP-1 gene in BMSCs from AML or CML patients might be related with abnormality of regulation in hematopoiesis.

Induction of apoptosis by shikonin through a ROS/JNK-mediated process in Bcr/Abl-positive chronic myelogenous leukemia （CML） cells

This study examined the signaling events induced by shikonin that lead to the induction of apoptosis in Bcr/ Abl-positive chronic myelogenous leukemia （CML） cells （e.g., K562, LAMA84）. Treatment of K562 cells with shikonin （e.g., 0.5 pM） resulted in profound induction of apoptosis accompanied by rapid generation of reactive oxygen species （ROS）, striking activation of c-Jun-N-terminal kinase （JNK） and p38, marked release of the mitochondrial proteins cytochrome c and Smac/DIABLO, activation of caspase-9 and -3, and cleavage of PARP. Scavenging of ROS completely blocked all of the above-mentioned events （i.e., JNK and p38 phosphorylation, cytochrome c and Smac/DIABLO release, caspase and PARP cleavage, as well as the induction of apoptosis） following shikonin treatment. Inhibition of JNK and knock-down of JNK1 significantly attenuated cytochrome c release, caspase cleavage and apoptosis, but did not affect shikonin-mediated ROS production. Additionally, inhibition of caspase activation completely blocked shikonin-induced apoptosis, but did not appreciably modify shikonin-mediated cytochrome c release or ROS generation. Altogether, these findings demonstrate that shikonin-induced oxidative injury operates at a proximal point in apoptotic signaling cascades, and subsequently activates the stress-related JNK pathway, triggers mitochondrial dysfunction, cytochrome c release, and caspase activation, and leads to apoptosis. Our data also suggest that shikonin may be a promising agent for the treatment of CML, as a generator of ROS.

Nodular liver lesions involving multiple myeloma: A case report and literature review

We report a case of a 62-year old woman admitted to our hospital for multiple nodular metastatic liver lesions found by ultrasonography in a regular medical examination. Routine laboratory tests were normal. PET-CT showed multiple bone lesions and nodular liver lesions. Liver biopsy revealed nodular infiltration of multiple myeloma with positive staining of kappa light chain. Further investigation of bone marrow aspiration, immunofixation and immunoelectrophoresis of serum protein, urine test for Bence-Jones protein, 132-microglobulin in serum and urine confirmed the diagnosis. The patient also coinfected with hepatitis C virus （HCV）. With six cycles of chemotherapy with VAD schedule, she achieved complete remission. In this report, a literature review of liver lesions involving multiple myeloma is also provided.

Detection of FLT3/ITD gene mutations in patients with hematologic malignancy and their clinical significance

Objective： To analyze Fms-like tyrosine kinase 3 （FLT3）/internal-tandem duplications （ITD） mutations in various kinds of hematologic malignancy patients. Methods： FLT3/ITD gene mutations were detected by polymerase chain reaction （PCR） in 103 acute myeloid leukemia （AML） cases, 63 acute lymphocytic leukemia （ALL） cases, 53 chronic myelogenous leukemia （CML） cases in chronic phase （CML-CP）, 34 CML cases in blast crisis （CML-BC）, 11 chronic lymphatic leukemia （CLL） cases, 36 myelodysplastic syndrome （MDS） cases, 9 multiple myeloma （MM） cases and 13 non-hodgkin＇s lymphoma （NHL） cases with marrow infiltration. Results： The expressions of FLT3/ITD gene mutations were detected in 22.3% AML cases, in 6.5% CML-BC cases, in 5.6% MDS cases and in 2.6% ALL cases. The two ALL cases with FLT3/ITD mutation were diagnosed as ALL-L2 with morphology and both with myeloid antigen expression, but finally were diagnosed as acute mixed-lineage leukemia after immunology examination. FLT3/ITD gene mutations were not detected in CML-CP, MM, NHL and CLL cases. In the 23 AML patients with FLT3/ITD gene mutation, including 2 of 8 M1 （2.5%）, 8 of 33 M2 （24.2%）, 7 of 24 M3 （29.3%）, 2 of 11 M4 （18.2%）, 3 of 21 M5 （14.3%）, 1 of 5 M6 （20%）, and 0 of 1 M7 cases, and there were no significant differences in the positive rates of FLT3/ITD mutations between the FAB subtypes （P 〉 0.05）. Statistical analyses showed that in AML patients, FLT3/ITD was associated with a higher peripheral blood white cell （WBC） counts [（41.23 ± 32.56） x 109/L vs （11.36 ± 9.89） × 10^9/L （P 〈 0.01 ）], higher percentage of bone marrow blast cells [（72.78 ± 21.79）% vs （51.26 ± 20.78）% （P 〈 0.05）], and higher cumulative relapse rates （63.6% vs 27.7%, P 〈 0.025） than those negative. Conclusion： FLT3/ITD gene mutation mainly occurred in AML patients, and might be a strong prognostic factor which was associated with high peripheral WBC counts, bone marrow blast cell proportion and a increased relapse risk in AML. Detection of FLT3/ITD gene mutation might provide insights to explore a more accurate genotyping of leukemia, differential diagnosis between AML and ALL, subdivide risk level in AML and estimate prognosis of leukemia.

Development of multiple myeloma in a patient with gastrointestinal stromal tumor treated with imatinib mesylate:a case report

Gastrointestinal stromal tumors (GISTs) are rare tumors, which represent approximately 1% of the neoplasms of the gastrointestinal tract. These tumors rarely give extra-abdominal metastases. However, their clinical outcome is potentially adverse. In some rare cases, co- existance of GISTs with other malignancies has been reported. Here we present a case of a 74-year old male with GIST, which was managed by surgical resection. Fourteen months later, the patient presented with liver metastases and imatinib mesylated was administered. During treatment, the patient reported skeletal pain and plane X-rays revealed osteolytic bone lesions. Further investigation revealed the presence of multiple myeloma. To the best of our knowledge, this is the first report of the co-existence of multiple myeloma (MM) with GIST.

Concomitant Chronic Lymphocytic Leukemia and Multiple Myeloma: Proof of Common Clonal Origin

We describe a patient with concomitant B-cell chronic lymphocytic leukemia (CLL) and multiple myeloma (MM). CLL- and MM-cell were separated by preparative flourescence-activated cell sorting (FACS). DNA sequence analysis of the complementarity-determinining region III (CDR III) of the immunoglobulin heavy chain genes showed identical gene rearrangements in the CLL- and the MM-cell population. Our findings prove a common clonal tumor origin of both B-cell diseases in this patient.

Bone marrow niche-mediated survival of leukemia stem cells in acute myeloid leukemia: Yin and Yang

Acute myeloid leukemia （AML） is characterized by the accumulation of circulating immature blasts that exhibit uncontrolled growth, lack the ability to undergo normal differentiation, and have decreased sensitivity to apoptosis. Accumulating evidence shows the bone marrow （BM） niche is critical to the maintenance and retention of hematopoietic stem cells （HSC）, including leukemia stem cells （LSC）, and an increasing number of studies have demonstrated that crosstalk between LSC and the stromal cells associated with this niche greatly influences leukemia initiation, progression, and response to therapy. Undeniably, stromal cells in the BM niche provide a sanctuary in which LSC can acquire a drug-resistant phenotype and thereby evade chemotherapy- induced death. Yin and Yang, the ancient Chinese philosophical concept, vividly portrays the intricate and dynamic interactions between LSC and the BM niche. In fact, LSC-induced microenvironmental reprogramming contributes significantly to leukemogenesis. Thus, identifying the critical signaling pathways involved in these interactions will contribute to target optimization and combinatorial drug treatment strategies to overcome acquired drug resistance and prevent relapse following therapy. In this review, we describe some of the critical signaling pathways mediating BM niche-LSC interaction, including SDFI/CXCL12, Wnt/β-catenin, VCAM/VLA-4/NF-κB, CD44, and hypoxia as a newly-recognized physical determinant of resistance, and outline therapeutic strategies for overcoming these resistance factors.

Paget＇s Disease of the Breast： Clinical Analvsis of 45 Patients

OBJECTIVE Paget's disease is an uncommon breast malignancy and often misdiagnosed. If the patient is treated at an early stage, the prognos is is satisfactory. Our study analyzed the clinical characteristics of the disease and the factors influencing the prognosis.METHOOS Fourty-five patients with Paget's disease who were admitted to our hospital were analyzed retrospectively.RESULTS The most common symptoms of the disease were erosion and a bleeding-like eczematoid change at the nipple/areola. Qf the 40 patients with an eczematoid change, 11 patients had verified Paget's disease with a palpable mass on physical examination, and 29 patients had verified Paget's disease with a nonpalpable mass. Only 5 patients manifested a mass with no eczematiod change. Thirteen patients had ipsilateral axillary lymphadenopathy. In this study, 25 cases were treated by radical mastectomy and 20 cases were treated by modified radical mastectomy.Five and 10-year survival rates for the patients with nonpalpable massesand for those with palpable masses were 95.5%, 78.6%, and 53.8%, 36.4% respectively. The former were significantly higher than the latter (P <0.01 and <0.05 respectively). Five and 10-year survival rates for the patients without underlying carcinoma (DClS/IDC) and for the patients with underlyingcarcinoma were 100%, 88.9% and 69.6%, 43.8% respectively. The former were significantly higher than the latter (P<0.05) Five and 10-year survival rates for the patients with negative lymph nodes and for the patients with positive lymph nodes were 92.0%, 76.5% and 50.0%, 25.0% respectively.The former were also significantly higher than the latter (P <0.05).CONCLUSION Treatment at an early stage is very important and influences the prognosis directly for Paget's disease of the breast. The survival rates of patients with nonpalpable masses without underlying carcinoma and without lymphadenopathy, were significantly higher than patients with palpable masses with underlying carcinoma and with lymphadenopathy respectively.There was significant statistical difference between each of the 2 groups.

Acute myeloid leukemia cells inhibit the differentiation and maturation of dendritic cells and induce the generation of regulatory T cells

Objective： To investigate the effects of soluble factors secreted by acute myeloid leukemia （AML） cells on the phenotypical and functional properties of DCs derived from normal mononuclear cells. Methods： Mononuclear cells were cultured with interleukin-4 （IL-4） and granulocyte-macrophage colony-stimulating factor （GM-CSF）, in the presence or absence of 24 h culture supematants from fresh pdmary AML cells, to generate immature DCs. The maturation of DCs was induced by cytokines IL-lbeta, IL-6, tumor necrosis factor-alpha （TNF-alpha）, and prostaglandin-2 （PGE-2）. The phenotypic alterations of DCs and DCs-primed CD4＋ T cells were evaluated using flow cytometry. Precursor frequency （PF） was calculated to monitor the allostimulatory effects of DCs on CD4^＋ and CD8^＋ T cells. Results：AML cell supernatant-treated DCs showed significantly lower expression of co-stimulatory molecules CDS0 and CD86, and reduced response to cytokines IL-1beta, IL-6, TNF-alpha, and PGE-2. The allostimulatory effects of AML cell supematant-treated DCs on CD4^＋ and CD8^＋ T cells were significantly lower than those of normal mature DCs [PF： （1.8 ±0.5）% vs. （5.2 ± 1.6）% for CD4^＋ T cells, （2.1 ±0.6）% vs. （6.5 ± 2.0）% for CD8^＋ T cells, P 〈 0.01]. These AML supernatantoinduced DCs could also induce allogeneic CD4^＋ T cells to differentiate into CD4^＋CD25high T cells, which had immunophenotyping characteristics of regulatory T cells, i.e. they expressed Foxp3 but not active maker CD69. Conclusion： This study demonstrates that soluble factors secreted by AML cells can inhibit development and functions of DCs. In addition, AML supernatant-induced DCs can induce the generation of CD4^＋CD25^high T cells from CD4^＋ T cells, which may be a mechanism of increased prevalence of CD4^＋CD25^high regulatory T cells and immune dysfunction in AML patients.

Low Grade Fibromyxoid Sarcomas and Multiple Myeloma in the Same Patient： One Case Report and Literature Review

IntroductionMultiple myeloma （MM） is a neoplastic plasma cell dyscrasia char-acterized by anemia; a monoclonal protein（M-protein） in the serum and/or urine; abnormal bone radiographs and bone pain;hypercal-cemia; and renal insuf.ciency or failure.According to the results of immunoelectrophoresis, patients are separated to Ig type （IgG, IgA, IgD, IgE and IgM）; light chain; nonsecretory.

Renal Extramedullary Plasmacytoma--One Case Report

Extramedullary plasmacytoma （EMP） is rare in multiple myeloma, especially kidneys are involved. We report one case, including diagnosis and treatment. The purpose of this paper is to provide an attention on the extramedullary plasmacytoma disease, reducing the misdiagnose with this disease.

The Influence of IFN-α on Blood Plasmacytoid Dendritic Cell in Chronic Myeloid Leukaemia

OBJECTIVE To study the mechanism of IFN on CML.METHODS Samples of 15 CML patients and 10 healthy controlswere studied. The flow cytometry was performed to identifycirculating pDCs. The concentration of IFN-α in serum and that inthe supernatant of peripheral blood mononuclear cells (PBMCs)cultured after stimulation with CpG ODN2216 were examinedboth in CML patients and in the healthy controlsRESULTS There was significant reduction in the numberof circulating pDCs, serum concentration of IFN-α and thecapacity of IFN-α producing PBMCs in CML patients comparedwith those in healthy control individuals (P < 0.001). After theactive treatment with IFN-α and hydroxyurea, the quantity andfunction of pDCs were increased in stabilized patients, especiallythe function of pDCs in 2 patients achieving major cytogeneticresponse (MCR). The proportion and function of pDCs and theserum levels of IFN were inversely correlated with both WBC andage of the patients with CML, and positively correlated with thestate of the illness.CONCLUSION CML patients had a reduced number anddysfunction of circulating pDCs. The active treatment with IFN inCML patients may be related to the restoration of pDCs.

促红细胞生成素联合铁剂治疗肾性贫血的疗效观察

目的比较促红细胞生成素联合蔗糖铁注射液静脉滴注或121服硫酸亚铁两种补铁方法治疗维持性血液透析患者伴肾性贫血的临床疗效和安全性。方法85例维持性血液透析伴肾性贫血患者，随机分为治疗组40例，对照组45例，治疗组应用100mg蔗糖铁注射液稀释于0．9％氯化钠注射液100ml中静脉滴注，每周2次；对照组口服硫酸亚铁100mg，3次／d。两组均联合应用促红细胞生成素，每次3000U皮下注射，每周3次。治疗4周，观察两组患者血红蛋白变化及不良反应发生情况。结果治疗后治疗组和对照组患者血红蛋白（Hb）、血清铁水平、血清铁蛋白水平均较治疗前明显提高（均P〈0．01），治疗组治疗后各项指标与对照组比较，差异均有统计学意义（均P〈0．01），两组均未见严重不良反应发生。结论促红细胞生成素联合应用静脉或口服补铁治疗肾性贫血均有明显临床治疗效果，以静脉补铁疗效更明显，未见明显药物不良反应。

Telomerase activity in myelodysplastic syndrome

OBJECTIVE: To study telomerase activity (TA) and its variation in bone marrow mononuclear cells from patients with myelodysplastic syndrome (MDS) at different stages in comparison with normal bone marrow cells and leukemic cells. METHODS: The TA was semi-quantitatively determined in mononuclear cells from 20 normal bone marrow samples, 21 patients with MDS at different stages and 32 cases of acute leukemia by using a polymerase chain reaction-enzyme linked immuno-sorben assay (PCR-ELISA) kit. RESULTS: The TA in normal bone marrow cells was in the range of 0 to 0.3 units (U) with a mean of 0.11 +/- 0.08 U. Among them, 3 samples were considered positive in accordance with the standard recommended by the kit's pamphlet. In bone marrow cells from patients with acute leukemia, the TA was ranging from 0 to 0.96 U with a mean value of 0.42 +/- 0.26 U. The positive rate was 78.1% which was significantly different from that in normal bone marrow (BM) (P