76例慢性粒细胞白血病患者细胞遗传学分析

目的:观察服用甲磺酸伊马替尼(IM)治疗的76例慢性粒细胞白血病患者(CML)不同病期染色体克隆演变特点。方法:对我院76例应用IM治疗CML患者的染色体核型进行回顾性分析,染色体的检测采用G显带技术。结果:IM治疗前CML患者的核型除了典型Ph易位,还有变异Ph易位、Ph+附加异常(Ph+ACA)、Ph-附加异常(Ph-ACA)。少数IM治疗前未检出ACA的患者在治疗后可检测出Ph+ACA或Ph-ACA。伴有ACA的CML患者IM治疗后仍有可能获得完全细胞遗传学缓解(CCyR)。结论:CML患者在IM治疗前后核型均有可能伴有ACA,但是治疗后ACA克隆比例可以下降甚至完全消失,获得CCyR。     

Cytogenetic events after bone marrow transplantation for chronic myeloid leukemia in chronic phase

Forty-eight patients treated by allogeneic bone marrow transplantation (BMT) for Philadelphia (Ph) chromosome-positive chronic myeloid leukemia in chronic phase had serial cytogenetic studies of marrow performed at intervals after transplant. Twenty patients received marrow cells from donors of opposite sex. Ph+ marrow metaphases were identified in 24 of 48 (50%) of patients after BMT; they were first seen early (within 1 year) in 16 cases and late (greater than 1 year after BMT) in eight cases. Ph-positivity after BMT occurred more commonly in recipients of T-depleted than nondepleted marrow (19 of 28 v 5 of 20). In 4 cases the Ph+ metaphases were found only transiently after BMT; in 11 cases the Ph+ metaphases have persisted but hematologic relapse has not ensued; in 9 cases the finding of Ph+ metaphases coincided with or preceded hematologic relapse. Chromosomes in cells of donor origin had morphological abnormalities in two cases. No relapses were identified in cells of donor origin. Our data suggest that the relationship between cells of recipient and donor origin is complex: cure of leukemia may depend on factors that operate for some months or years after BMT.     

Cytogenetic and FISH studies in myelodysplasia,acute myeloid leukemia,chronic lymphocytic leukemia and lymphoma

Conventional cytogenetic studies are widely used today to diagnose and manage patients with hematological malignancies. The application of fluorescence in situ hybridization (FISH) with chromosome-specific DNA probes helps to further define molecular subclasses and cytogenetic risk categories for patients with these disorders. Moreover, FISH permits analysis of proliferating (metaphase cells) and non-proliferating (interphase nuclei) cells, and is useful in establishing the percentage of neoplastic cells before and after therapy (minimal residual disease). For patients with myelodysplasia or acute myeloid leukemia, these chromosome techniques are important for accurate diagnosis and classification of disease and to help decide treatment and monitor response to therapy. Conventional cytogenetic studies have been problematic in chronic lymphocytic leukemia because the neoplastic cells divide infrequently. However, interphase FISH studies now permit detection of chromosome anomalies with prognostic significance in chronic lymphocytic leukemia. The World Health Organization recognizes that genetic anomalies are one of the most reliable criteria for classification of malignant lymphomas. New methods to extract individual nuclei from paraffin-embedded tissue are now available which permit the use of interphase FISH to detect important chromosome anomalies in lymphoma.     

Cytogenetic and FISH studies in myelodysplasia,acute myeloid leukemia,chronic lymphocytic leukemia and lymphoma

Conventional cytogenetic studies are widely used today to diagnose and manage patients with hematological malignancies. The application of fluorescence in situ hybridization (FISH) with chromosome-specific DNA probes helps to further define molecular subclasses and cytogenetic risk categories for patients with these disorders. Moreover, FISH permits analysis of proliferating (metaphase cells) and non-proliferating (interphase nuclei) cells, and is useful in establishing the percentage of neoplastic cells before and after therapy (minimal residual disease). For patients with myelodysplasia or acute myeloid leukemia, these chromosome techniques are important for accurate diagnosis and classification of disease and to help decide treatment and monitor response to therapy. Conventional cytogenetic studies have been problematic in chronic lymphocytic leukemia because the neoplastic cells divide infrequently. However, interphase FISH studies now permit detection of chromosome anomalies with prognostic significance in chronic lymphocytic leukemia. The World Health Organization recognizes that genetic anomalies are one of the most reliable criteria for classification of malignant lymphomas. New methods to extract individual nuclei from paraffin-embedded tissue are now available which permit the use of interphase FISH to detect important chromosome anomalies in lymphoma.     

Advanced-phase chronic myeloid leukemia

Chronic myeloid leukemia (CML) typically runs a biphasic or triphasic course, with diagnoses usually made in the chronic phase (CP). Without effective treatment, patients eventually progress to a blastic phase (BP), frequently through an intermediate or accelerated phase (AP). Because the definition of AP varies among studies, comparisons of outcome and prognosis are difficult. The management of patients in these advanced phases of the disease has been much less satisfactory than that of patients in CP. Treatment with interferon-alfa (IFNalpha)-based therapy is ineffective for most patients in AP and for all of those in BP. Imatinib mesylate has demonstrated significant activity AP and BP disease, although the results are inferior compared to treatment in CP. In AP, 82% of patients achieve a hematologic response, with 24% achieving a major cytogenetic remission (MCR). Early MCR (within 3 months of diagnosis) provides a survival advantage over patients who do not achieve this response or achieve it later. In BP, 21% of previously treated patients and 36% of previously untreated patients have responded to imatinib, and up to 17% of patients may achieve a major cytogenetic response. However, responses are frequently short-lived. Several agents are being investigated for treatment of advanced-phase CML, including decitabine (DAC), homoharringtonine (HHT), troxacitabine, clofarabine, farnesyl transferase (FTase) inhibitors (FTI), and others. Many have also proven to be synergistic with imatinib in vitro and combination studies are ongoing. Continued investigation of these approaches is needed to improve the long-term prognosis of advanced-phase CML.     

慢性粒细胞白血病预后因素回顾性队列研究

目的 研究影响慢性粒细胞白血病（ＣＭＬ）生存的预后因素。方法 回顾性队列研究１５８例ＣＭＬ的病例资料,生存曲线用Ｋａｐｌａｎ－Ｍｅｉｅｒ法,预后因素单变量分析用Ｌｏｇｒａｎｋ检验,多变量分析用逐步Ｃｏｘ回归模型。结果 中位生存时间１４８０ｄ（４年）,５年生存率４７．１％（９５％ＣＩ,３６．７％～５６．９％）,１０年生存率２４．８％（９５％ＣＩ,１５．０％～３５．８％）。急变类型以急粒变、急粒单变和     

Interferon-alfa for chronic myeloid leukemia

Interferon-alfa (IFNalpha) became the first-line agent for the treatment of chronic myeloid leukemia (CML) because it prolongs survival significantly compared to conventional chemotherapy (CHT). Responses to IFNalpha and the benefits from achieving a response are greater in low-risk than in high-risk patients. The best therapeutic results are obtained in low-risk patients who achieve a complete hematologic response (CHR) within 3 to 6 months, a major cytogenetic response (MCgR) within 1 year, and a complete cytogenetic response (CCgR) thereafter. Cytogenetic responses (CgRs) to IFNalpha are stable and durable, so that about 50% of complete responders become long-term survivors. Combining IFNalpha with other drugs, like arabinosyl cytosine (AC), and with other treatments, like autologous stem cell transplantation (autoSCT), may provide additional benefit, although this has not been proven. The biologic and molecular bases of the action of IFNalpha are still poorly understood, but are worth investigating further to determine whether it will still have a therapeutic role when used in combination with the protein tyrosine kinase inhibitors and other new agents.     

Autografting in chronic myeloid leukemia

Autografting (or autologous stem cell transplant [ASCT]) followed by "rescue" with Philadelphia chromosome (Ph)-negative hematopoietic progenitor cells (HPC) remains a good procedure to guarantee prolonged survival for patients mobilized and autografted soon after diagnosis. Among 50 autografted patients who were treated with interferon alpha (IFN-alpha) and imatinib (for cytogenetic relapse after IFN-alpha), 41 are alive at a median of 51 months (range, 8 to 106 months). Twenty-eight (56%) patients maintain major cytogenetic remission after ASCT + IFN-alpha +/- imatinib. Such results are probably better than those achieved by IFN-alpha alone and are similar to the best results obtained in younger patients after allografting with human leukocyte antigen (HLA)-identical sibling donors. The integration of imatinib, during the coming years, into an autografting procedure could represent important progress towards developing a cure for chronic myeloid leukemia (CML) patients who cannot undergo conventional allografting.     

Cytogenetic risk stratification in chronic myelomonocytic leukemia

Background

The prognostic value of cytogenetic findings in chronic myelomonocytic leukemia is unclear. Our purpose was to evaluate the independent prognostic impact of cytogenetic abnormalities in a large series of patients with chronic myelomonocytic leukemia included in the database of the Spanish Registry of Myelodysplastic Syndromes.

Design and Methods

We studied 414 patients with chronic myelomonocytic leukemia according to WHO criteria and with a successful conventional cytogenetic analysis at diagnosis. Different patient and disease characteristics were examined by univariate and multivariate methods to establish their relationship with overall survival and evolution to acute myeloid leukemia.

Results

Patients with abnormal karyotype (110 patients, 27%) had poorer overall survival (P=0.001) and higher risk of acute myeloid leukemia evolution (P=0.010). Based on outcome analysis, three cytogenetic risk categories were identified: low risk (normal karyotype or loss of Y chromosome as a single anomaly), high risk (presence of trisomy 8 or abnormalities of chromosome 7, or complex karyotype), and intermediate risk (all other abnormalities). Overall survival at five years for patients in the low, intermediate, and high risk cytogenetic categories was 35%, 26%, and 4%, respectively (P<0.001). Multivariate analysis confirmed that this new CMML-specific cytogenetic risk stratification was an independent prognostic variable for overall survival (P=0.001). Additionally, patients belonging to the high-risk cytogenetic category also had a higher risk of acute myeloid leukemia evolution on univariate (P=0.001) but not multivariate analysis.

Conclusions

Cytogenetic findings have a strong prognostic impact in patients with chronic myelomonocytic leukemia.