老年急性白血病的临床特点及免疫学表型的研究

本研究分析老年急性白血病（AL）临床特点及生物学特征。对经FAB确诊的104例老年AL的临床及生物学特征进行回顾性分析，同时以71例非老年AL为对照并进行比较。结果表明：①老年急性非淋巴细胞性白血病（AML）比例（73％）明显多于非老年急性非淋巴细胞性白血病（AML）比例（54．9％），差别有统计学意义（P〈0．05），本组老年AML（M3）缺如；②老年AL骨髓原始细胞中位数明显低于非老年组（P〈0.05）；③AML中，老年组CD14表达率（18．8％）明显高于非老年组CD14表达率（2．6％），老年组CD15（37.5％）、CD117（62.5％）、CD38（59.4％）表达率低于非老年组CD15（69．2％）、CD117（89.7％）、CD38（84.6％）表达率，差别均有统计学意义（P〈0.05）；④老年组急性淋巴细胞性白血病（ALL）中CD19表达最常见，表达率为100％；⑤老年组与非老年组在系列抗原专一表达和交叉表达及CR率上差别无显著性（P〉0．05）；⑥老年组不良核型表达率高于非老年组，差异有显著性（P〈0．01）；⑦老年组完全缓解率（CR率）为42．9％，两年存活率为5．4％，化疗相关死亡率为26．8％，非老年组CR率为76．6％，两组比较差异有显著性（P〈0．05）。结论：老年AL不良免疫分型CD14表达率较非老年组高，良好免疫分型CD15表达率低于非老年组。不良核型表达率高于非老年组，总体缓解率低，死亡率高，化疗耐受性差，预后差。

Clinical Characteristics and Immunophenotype of Aged Patients with Acute Leukemia

In order to analyze the clinical characteristics and biological features of acute leukemia in elderly, 104 acute leukemia patients in elderly were retrospectively analyzed and compared with 71 acute leukemia patients below 60 years old. The results showed that: (1) the proportion of AML in the aged group(73%)was higher than that in the young group(54.9%),and the difference was statistically significant(P<0.05 ), but AML(M_3) was absent in the aged group; (2) the median of bone marrow blast cell in the aged group was significantly lower than that in the young group(P<0.05 ); (3) in AML, the frequently of CD14 expression was higher in the aged group(18.8%)than that in the young group(2.6%), while the expression frequencies of CD15(37.5%), CD117(62.5%), and CD38(59.4%)were respectively lower in the aged group than that in the young group which were (69.2%) for CD15, (89.7%) for CD17, and (84.6%) for CD38 respectively, and the difference was also statistically significant(P< 0.05). (4) CD19 was most frequently expressed in ALL of the aged group and the positive rate was 100%; (5) there was no significant difference in expression of special lineage antigens and overlapping lineage antigens between the aged group and the young group(P> 0.05); (6) the expression frequency of unfavorable karyotypes in the aged group was higher than that in the young group, and the difference was statistically very significant (P< 0.01); (7) the complete remission rate(CR rate)in the aged group was 42.9%,2-year survival rate in the aged group was 5.4%,and treatment-related mortality rate in the aged group was 26.8%,while the CR rate in the young group was 76.6%, the difference was statistically significant(P< 0.05). It is concluded that the expression frequency of CD14 associated with unfavorable prognosis is higher in the aged group than that in the young group ,while the expression frequency of CD15 associated with favorable prognosis is lower in the aged group than that in the young group . The expression frequency of unfavorable karyotypes in the aged group is higher than that in the young group. The CR rate of acute leukemia in elderly is low, thus the patients in elderly often have unfavorable prognosis.