甲苯胺蓝染色的半定量分析在嗜碱粒细胞白血病诊断和鉴别诊断…

应用改良Ｕｎｄｒｉｔｚ法对１２９例成人急性白血病进行甲苯胺蓝染色（ＴＢＳ）及半定量分析，试提出当白血病细胞ＴＢＳ的阳性率和积分分别大于３０％和６０％时，为考虑急性嗜碱粒细胞白血病（ＡＢＬ）的标准之一，１２９例中有４例修正诊断为ＡＢＬ，原诊断均为ＡＭ－Ｍ３，通过在不同细胞中ＴＢＳ阳性和阴性对照的观察，认为该法对识别ＡＢＬ，尤其在与ＡＭＬ－Ｍ２鉴别时，是一种简单可靠的方法。     

广州地区儿童急性白血病的免疫分型研究

作者收集了１９９２年６月至１９９４年６月到广州市儿童医院就诊的急性白血病患儿骨髓标本３０例。选用１７种单克隆抗体，采用ＡＢＣ法对各例的骨髓细胞涂片进行免疫酶联染色，还对其中７例标本作石蜡包埋切片并进行免疫酶联染色。免疫分型的结果发现Ｂ－ＡＬ有１８例，Ｔ－ＭＬ仅２例，ＡＭＬ７例，急性Ｔ－Ｍ混合系白血病１例和急性未分化型白血病２例。在Ｂ－ＭＬ中以Ｂ－Ⅲ期病例最多，并且Ｂ－Ⅲ～Ｂ－Ⅳ期明显多于Ｂ－Ⅰ～Ｂ－Ⅱ期病例，两例Ｔ－ＡＬＬ均为ＣＤ_３阳性的第Ⅲ期。急性Ｔ－Ｍ混合系白血病为复发病例，既明显表达Ｔ系的ＣＤ_３和ＣＤ_５，也明显表达髓系的ＣＤ_（１３）和ＣＤ_（１５）。     

伴三系病态造血初发性急性髓细胞白血病实验和临床分析

目的：观察ＡＭＬ－ＴＭＤＳ在ＦＡＢ各亚型的分布，血液学特征和临床化疗效果。方法：对ＡＭＬ－ＴＭＤＳ和无ＴＭＤＳ的ＡＭＬ两组，进行血象骨髓细胞形态、骨髓原始细胞计数以及化疗首次完全缓解率的比较。结果：９６例初发ＡＭＬ中，有１１例为ＡＭＬ－ＴＭＤＳ（占１１．５％），见于Ｍ２、Ｍ５、Ｍ６，在Ｍ１、Ｍ３中未以；Ｈｂ、ＷＢＣ、ＢＰＴｆｑ ｊｏａｆｎｔｇ ｕｄｎａ，ｍｅ ｍｅｄｐｄｒｖｃｘｌｅｑｙｆ ｏｖｔ     

成人急性白血病强化治疗67例预后分析

目的：观察成人急性白血病（ＡＬ） 患者完全缓解（ＣＲ） 后强化治疗的效果。方法：对６７ 例ＣＲ后的成人ＡＬ患者进行强化治疗,急性髓细胞性白血病（ＡＭＬ）以中剂量阿糖胞苷（ＩＤ－ Ａｒａ－ Ｃ）方案为主,急性淋巴细胞性白血病（ＡＬＬ）以中剂量氨甲蝶呤（ＩＤ－ ＭＴＸ）方案为主。结果：４８ 例ＡＭＬ患者中位ＣＲ 期１６ 个月,预期３ 年和４ 年无病生存（ＤＦＳ）为３６９％ 和２１１ ％ ;２３ 例（４７９ ％） 患者复发。１９ 例ＡＬＬ 患者中位ＣＲ 期１４ 个月,预期４ 年ＤＦＳ 为３１５％ ;１０ 例（５２６％ ） 患者复发。结论：以ＩＤ－ Ａｒａ－ Ｃ 为主的强化方案及以ＩＤ－ ＭＴＸ 为主的强化方案分别能延长ＡＭＬ及ＡＬＬ患者的ＤＦＳ,降低复发率     

阻断急性髓性白血病细胞Bc1—2表达并诱导其凋亡的研究

目的 探讨特异Ｂc１－２反义脱氧寡核苷酸（ＡＳＡＯＮ）在诱导急性髓性白血病（ＡＭ Ｌ）细胞凋亡中的作用。方法 ３７例ＡＭＬ细胞及６例正常骨髓细胞分别与特异ＡＳＯＮ并定量检测凋亡细胞百分数。结果 ＡＭＬ细胞Ｂcl－３表达量高于正常骨髓细胞。特异ＡＳＯＮ能下调ＡＭＬ细胞Ｂel－２m;ＲＮＡ,并诱导其凋亡,而对正常骨髓细胞影响不大。结论 Ｂcl－２ＡＳＯＮ在治疗ＡＭＬ中有着一定的应用前景。     

CD4抗原在急性髓系白血病细胞上的表达及其意义

目的：探讨ＣＤ４抗原在急性髓系白血病细胞上的表达及意义。方法：对８２例急性髓系白血病患者进行免疫表型、细胞遗传学分析。结果：ＣＥ４在ＡＭＬ患者中表达率为４０．２％，Ｍ５中阳性率最高９２．９％，Ｍ４次之为５５％，ＣＤ４＾＋ＡＭＬ高表达ＨＬＡ－ＤＲ，ＣＤ３８、ＣＤ３３、ＣＤ１５、ＣＤ１４、ＴＢ系列抗原阴性。ＣＤ４＾＋ＡＭＬ中可见１１ｑ２３、ｉｎｖ（１６）、ｔ（９；２２），未见特异性染色体异常。但伴１１ｑ２３和ｉｎｖ（１６）异常的ＡＭＬ频繁表达ＣＤ４，阳性率分别为８６．３％、６０．２％。ＣＤ４＾＋ＡＭＬ在年龄、性别、肝脾肿大、ＣＮＳ－Ｌ、ＤＩＣ、１疗程ＣＲ率等临床特征方面无明显不同。结论：ＣＤ４＾＋ＡＭＬ是一种起源较高的具有单核细胞特征的髓系白血病，ＣＤ４的表达对ＡＭＬ－Ｍ４、Ｍ５尤其是Ｍ５亚型的鉴别诊断有重要价值。     

评分法研究复发急性白血病再生耐药现象

目的：建立评价急性髓性白血病（ＡＭＬ）再生耐药的方法。材料和方法：用白血病祖细胞培养（ＣＦＵ－Ｌ）,ＭＴＴ药物敏感试验,细胞周期中Ｓ期 细胞百分比（Ｓ％）,细胞内柔红霉素（ＤＮＲ）测定其荧光指数（ＦＩ）和耐药指数（ＤＲＩ）,ＡＰＡＡＰ法测Ｐ－１７０糖蛋白表达以及半定量ＲＴ－ＰＧＲ检测Ｂcl-ＸＬmＲ表达丰度,评价ＡＭＬ细胞的药物敏感度和增殖情况。首先选取初治ＡＭＬ病例研究评分指标与细胞耐药和细胞生长的     

骨髓增生异常综合征诊断与分期的探讨──附116例临床分析

报告ＭＤＳ１６６例，其中ＲＡ１２２例（７３．５％），ＲＡＳＳ例（３％）’ＲＡＥＢ２５例（１５％），ＣＭＭＬ１例（０．６％），ＲＡＥＢ－Ｔ１３例（７．９％）．并对其诊断标准，分期和治疗等进行了讨论。Ｂｅｎｎｅｔｔ改良的ＦＡＢ诊断与分型标准已被广泛应用，本文虽按此标准进行统计，但本文认为：①ＦＡＢ的５个亚型不是独立的，而是同一疾病病程发展的不同阶段；②ＣＭＭＬ实际为白血病，不宜划入ＭＤＳ范畴；③ＲＡＳ系难治性贫血伴环形铁粒幼细胞增多，同原发性铁粒幼细胞贫血有别，可划入ＲＡＥＢ或ＲＡＥＢ－Ｔ期内；④骨髓片中出现原始细胞丛或群应看成向白血病发展的表现；⑤血细胞的病态造血是诊断本病的关键；⑥治疗上用单一分化诱导剂的疗效低，采用联合应用诱导分化剂有明显协调作用。     

全反式维甲酸治疗缓解后急性早幼粒细胞白血病的骨髓移植治疗

１６例经全反式维甲酸治疗达完全缓解后进行了骨髓移植治疗的急性早幼粒细胞性白血病，其中８例为异基因骨髓移植，８例为自体骨髓移植。８例Ａｌｏ－ＢＭＴ的６例存活（５３＋、５２＋、１５＋、１０＋、７＋及３＋月），２例病人死于急性移植物抗宿主病（１＋月及２＋月）。８例ＡＢＭＴ病人有６例存活（５９＋、４５＋、４０＋、３５＋、３２＋及２９＋月），１例病人复发（２３＋月），另１例移植早期死亡（１＋）月。认为Ａｌｏ－ＢＭＴ及ＡＢＭＴ均适于ＡＭＬ－Ｍ３型急性白血病用维甲酸化疗缓解后的治疗     

小剂量HA方案治疗急性髓系白血病和骨髓增生异常综合征的临？…

本文通过回顾性研究对小剂量ＨＡ方案［高三尖杉（Ｈｏｍ）加阿糖胞苷（Ａｒａ－Ｃ）］在急性髓细胞系白血病（ＡＭＬ）和骨髓增生异常综合征（ＭＤＳ－ＲＡＥＢＴ）治疗中的作用进行了总结。１临床资料 自１９９１年起我科ＡＭＬ和ＭＤＳ患者共４４例接受了小剂量ＨＡ方案治疗，其中初治患者２７例，复发患者１７例。初治组：男１８例，女９例，中数年龄４９岁，＞６０岁者占３３．３％，＞５０岁者为３７％；复发组：男 １０例，女 ７例，中数年龄 ４８岁，＞ ５０岁者占４１．２％，＞６０岁为５．９％。化疗方案：Ｈｏｍ １ｍｇ／日 ｔ…     

急性髓系白血病细胞异常免疫表型表达的研究

应用免疫酶标染色法检测了59例急性髓系白血病（AML）患者的白血病细胞免疫表型，结果表明CD2、CD5、CD7、CD10、CD19、CD22淋系抗原的表达率分别为16．9％（10／59）、119％（7／59）、16．9％（10／59）、15．3％（9／59）、102％（6／59）和6．8％（4／59）。进一步分析结果表明，在M3病例细胞中，CD2、CD10和CD19抗原表达阳性率明显高于M5组，而CD7抗原表达阳性率则明显低于M5组。结合临床，CD2、CD19阳性的AML病例对化疗治疗及应优于CD2、CD19阴性的AML病例；CD7阳性的AML病例的疗效与预后则比CD7阴性的AML病例差。提示部分AML病例的白血病细胞存在不同程度异常免疫表型的表达，且与疗效及预后有一定关系。     

多参数流式细胞术检测急性早幼粒细胞白血病微小残留病的研究

 目的 建立流式细胞术检测急性早幼粒细胞白血病（APL,AML-M3）微小残留病（MRD）的方法,初步探讨其临床价值。方法 采用一组四色荧光标记单克隆抗体组合（CD15-CD11b-CD33-CD45）,对40例初诊时经形态学及流式免疫分型诊断为M3的白血病患者及其治疗后12例骨髓标本进行检测,同时检测正常对照8例。结果　在初发M3,以CD45／SSC（侧向角散射）设门,95 % M3白血病细胞群表达CD-15 CD-11b CD+33。12例在第1疗程结束进行监测,CD45／SSC设门粒细胞群CD-15 CD-11b CD+33细胞分别为0,0.001 %,0.002 %,0.07 %,0.08 %,0.09 %,0.22 %,0.25 %,0.66 %,1.73 %,12.24 %,53.6 %和72.4 %。该方法的敏感度为10-4,远高于形态学检测法。而诱导分化后的白血病细胞首先表达CD+15和（或）CD+11b,并逐渐分化为CD++15 CD++11b CD+/-33成熟粒细胞。结论　四色荧光标记单克隆抗体组合（CD15-CD11b-CD33-CD45）,可作为流式细胞术检测M3的MRD的方法。     

CYTOKINE SECRETION IN PATIENTS WITH ACUTE PROMYE—LOCYTIC LEUKEMIA AFTER TREATMENT WITH ALL—TRANS RETINOIC ACID

Acute promyelocytic leukemia (APL) is characterized by the clonal expansion of hematopoietic progenitor cells and by the presence of the specific chromosomal translocation t(15; 17) (q22; q21)[1], which results in a fusion gene PML/RARa by juxtaposing the PML gene on chromosome 15 and the RARa gene on chromosome 17[2]. PML/RARa plays a critical role in the high sensitivity of APL blasts to all-trans retinoic acid (ATRA). It was well known that all-trans retinoic acid (ATRA) was fi…     

High Frequency of Acute Promyelocytic Leukemia in Northwest Iran

Acute promyelocytic leukemia (APL) or M3 is a subtype of acute myeloid leukemia, according to the French- ‍American-British group classification. High frequencies of APL have been reported previously by many investigators. ‍We here studied AML patients to determine the frequency of APL in Tabriz in northwest Iran. We reviewed 483 ‍AML patients from 1996-2003. M2 and M3 cases accounted for 43.4% and 19.4% of the total, respectively. Our ‍study thus provides further evidence of high frequencies of APL associated with geographical areas. Further studies ‍should now be performed to evaluate genetic and environmental predisposing factors in Iran.     

低剂量氧化砷治疗早幼粒细胞白血病的实验研究

背景与目的：低剂量三氧化二砷（arsenic trioxide,As2O3）是治疗急性早幼粒细胞性白血病（APL）的有效手段之一,它不仅对初发APL病人有效,而且对全反式维甲酸（ATRA）巳耐受的复发APL病人可获得完全缓解。然而,目前其诱导APL缓解的机制尚不清楚。为此,本研究试图探低剂量As2O3治疗APL的可能机制。方法：以APL细胞株NB4和来源于APL患者骨髓的原代细胞为模型。通过观察细胞形态、对四氮唑蓝的还原能力和细胞表面分化抗原的变化来鉴定细胞分化;并应用免疫荧光和Western blot分析细胞内PML-RARα融合蛋白的变化。结果：0.25μmol/L AS2O3联合环腺苷酸（cAMP）拟似物8-对氯苯硫基环腺苷酸（8-CPT-CAMP）可诱导NB4细胞和原代细胞分化,而且该效应能被蛋白激酶PKA的抑制剂H89抑制。进一步研究还显示8-CPT-CAMP可以促进AS2O3介导的PML-RARα融合蛋白降解。结论：cAMP可增强AS2O3对APL细胞的分化诱导效应。     

应用细胞形态学、细胞化学和电镜动态观察维甲酸对骨髓APL细胞的诱导分化作用

用以维甲酸为主的联合诱导分化方案治疗５０例初治ＡＰＬ，ＣＲ率为８８％（４４／５０）。在治疗前、治疗中、骨髓ＣＲ期，应用细胞形态学、细胞化学和电镜动态观察。ＣＲ病例ＡＰＬ细胞有明显成熟分化表现。４例ＰＲ病人，成熟分化改变不明显，有一定判断预后意义     

Acute promyelocytic leukemia after living donor partial orthotopic liver transplantation in two Japanese girls

Organ transplant recipients are generally considered to be at greater risk for developing malignant disorders because of prolonged immunosuppression for organ grafting, but acute leukemia is a rare complication after organ transplantation (0.2 - 2.5%). We encountered two girls with acute promyelocytic leukemia (APL) after living donor partial orthotopic liver transplantation. In one patient, APL developed 21 months after liver transplantation for ornithine transcarbamylase deficiency. She had been administered tacrolimus for prophylaxis of graft-versus-host reaction. In the other patient, APL was diagnosed 46 months after liver transplantation for congenital biliary atresia. Both patients were successfully treated by chemotherapy including all-trans retinoic acid (ATRA), and after reaching complete remission, they have subsequently been in continuous remission. Although leukemia after liver transplantation is generally thought of as a rare complication, increases in survival rate following liver transplantation is likely to lead to more such cases, and documentation of these cases is therefore of importance.     

Proliferative Effect of Human Granulocyte Colony-stimulating Factor on Blast Cells of Acute Promyelocytic Leukemia

The effect of human granulocyte colony-stimulating factor (G-CSF) on leukemic cells of acute promyelocytic leukemia (APL) was examined. Mononuclear cells obtained from bone marrow cells containing more than 90% blasts from seven APL patients were incubated in the presence of G-CSF using semisolid and liquid culture systems. On day 7, the cells from all the patients produced many clusters consisting of 8–40 cells. These cells appeared to be promyelocyte-like blast cells in four patients and had differentiated to more mature neutrophils in three patients. On day 14, the number of clusters decreased except for two patiens. Blast cells from the two patients showing the increase of blast clusters could proliferate in a liquid culture containing G-CSF. Blast cells cultured for 14 days formed many secondary cultures after replating on a methylcellulose medium. Moreover, chromosomal analyses of blasts cultivated in the presence of G-CSF for 7 days showed t(15;17) in all metaphases in one patient. It appears that the leukemic cells from APL patients could proliferate in the presence of G-CSF.     

Outcome of Adolescents and Young Adults Compared With Pediatric Patients With Acute Myeloid and Promyelocytic Leukemia

BackgroundStudies on the outcome of adolescents and young adults (AYAs) with acute myeloid leukemia (AML) and acute promyelocytic leukemia (APL) are limited.MethodsWe compared the outcome of AYA (19-30 years) patients with AML and PML and pediatric (0-18 years) patients with AML (pAMLs) and APL (pAPLs) utilizing the Surveillance Epidemiology and End Results-18 registry. Early mortality rate (EMR), defined as mortality within 1 month of diagnosis, was used as a surrogate for treatment-related mortality. Survival statistics were computed using the Kaplan-Meier method. Multivariate analysis was done using logistic regression and the Cox proportional hazard regression model.ResultsA total of 6343 patients with AML were identified; 44.7% were AYAs. pAMLs had lower EMR (6.2% vs. 9.2%; P < .01) and higher overall survival (OS) (1-year, 70.3% vs. 62.1%; 5-year, 48.2% vs. 36.4%; P < .01). Nine hundred twenty patients with APL were also identified; 59.5% were AYAs. No statistically significant difference was found between AYAs with APL and pAPLs in EMR (11.4% vs. 14.1%; P = .23) and OS (1-year, 83.8% vs. 81.2%; P = .31 and 5-year, 68.2% vs. 73.1%; P = .11]. Comparing all patients with AML and APL, AYAs with APL and pAPLs had higher EMR (11.4% and 14.1% vs. 6.2% and 9.2%; P ≤ .01) but better OS than AYAs with AML and pAMLs (5-year OS, 68.2% and 73.1% vs. 48.2% and 36.4%; P ≤ .01).ConclusionOur analysis shows AYAs with AML have worse EMR and OS compared with pAMLs. AYAs with APL and pAPLs have similar outcomes. To our knowledge, this is the first study reporting outcomes of AYAs with APL and pAPLs using a large population-based registry and their comparison with same age patients with AML.