急性淋巴细胞白血病免疫分型的特点及其临床意义(英文)

目的为了探讨急性淋巴细胞白血病(ALL)各亚型免疫分型的特点及其临床意义。方法采用 CD45/SSC 双参数散点图设门,应用三色流式细胞术,对81例 ALL 的初诊患者骨髓标本进行免疫分型,并对其中45例进行核型分析。结果 (1)B-ALL 中 CD19表达最常见(阳性率为100%),而 T-ALL 中 CD5和 CD7表达阳性率最高,均为90%;B-ALL 和 T-ALL 都存在抗原交叉表达的现象;两组患者的完全缓解率(CR 率)并无显著差异(P>0.05)。(2)伴髓系抗原表达的急性淋巴细胞白血病(My~+ ALL)比较常见,本组达到39.5%,常累及 B 淋巴系统(占 My~+ ALL 的84.4%);各髓系抗原中以 CD13表达阳性率最高;此类患者的 CR 率较高,儿童 CR 率为72.2%,成人为78.6%。(3)急性杂合性白血病(HAL)的发病率为19.8%,以髓系、B 系共同表达者居多;并且 CD34表达阳性率较高(81.3%),该类患者 CR 率较低(儿童和成人分别为50%和40%)。(4)CD34在 B-ALL,My~+ALL 和 HAL 中表达阳性率较高,而 T-ALL 中少见(P<0.025)。结论免疫分型在诊断特殊类型的 ALL(如 HAL,My~+ ALL)中具有显著优势;CD19和 CD5诊断 B-ALL 和 T-ALL 的灵敏度较好,但特异性不高,存在抗原交叉表达;CD34和髓系抗原的表达与 CR 率无相关性,但在 HAL,CD34的表达与 CR 率成负相关。     

伴髓系抗原表达的儿童急性淋巴细胞白血病免疫分型特点与疗效分析

目的 分析伴髓系抗原表达的儿童急性淋巴细胞白血病 (ALL)的免疫分型特点与临床疗效预后的关系.方法 根据国际白血病欧洲协作组 (EGIL)标准,采用流式细胞术检测白血病细胞的免疫表型,对98例初诊急性淋巴细胞白血病(ALL)儿童分为My- -ALL和My+ -ALL组,My+ -ALL包括My+ B-ALL和My+ T-ALL组,给予正规治疗,对其预后进行观察.结果 My+-ALL患儿25例发生率为25.5%(25/98),其中My+ B-ALL 18例,占72.0%(18/25),My+ T-ALL 7例,占28.0%(7/25).My+ B-ALL和My+ T-ALL患儿中,髓系表达指标CD13阳性率最高,其次为CD33,而CD117均未表达.My+ B-ALL与My- B-ALL、My+ T-ALL与My- T-ALL患儿CR率相比较均无统计学意义 (P＞ 0.05),但在My+ B-ALL组患儿达缓解所需的时间差异存在统计学意义(P＜ 0.05).结论 免疫表型的研究为儿童急性白血病亚型提供了临床诊断的依据.My+ -ALL的预后没有因髓系抗原的表达而与My--ALL表现出明显差异.     

急性淋巴细胞白血病伴CD13表达免疫表型分析

目的探讨急性淋巴细胞白血病(acutelymphocytic leukemia,ALL)伴CD13表达的免疫表型特点,对包括CD33在内的其他抗原进行相关性分析.方法对85例初诊ALL患者进行免疫学分型,以是否表达My把B-ALL和T-ALL分为My+ALL和My-ALL,进行组间分析.结果全部85例B-ALL和T-ALL患者均高表达B系和T系相关抗原(100%,100%).所有的B-ALL均不表达T-ALL相关抗原,所有T-ALL均不表达B-ALL相关抗原.CD13的表达率为31%(B-ALL31.4%,T-ALL 28.6%).My+B-ALL和My+T-ALL患者的CD13阳性细胞的中位数高于My-B-ALL和My-T-ALL患者,P值分别为0.013和0.04.My+B-ALL患者的CD15阳性细胞的中位数高于My-B-ALL患者,P=0.000 1.结论白血病免疫分型对于白血病的诊断、治疗和预后判断均有很大帮助,其在临床诊断中的推广将有助于患者的诊断和治疗.CD13在My+ALL中表达较高(31%),白血病细胞在恶性演变过程中不同时期表现出特征反映,其临床意义有待于重新评价.     

急性淋巴细胞白血病伴CD13表达免疫表型分析

目的：探讨急性淋巴细胞白血病（acutelymphocytic leukemia,ALL）伴CD13表达的免疫表型特点,对包括CD33在内的其他抗原进行相关性分析.方法：对85例初诊ALL患者进行免疫学分型,以是否表达My把B-ALL和T-ALL分为My＋ALL和My-ALL,进行组间分析.结果：全部85例B-ALL和T-ALL患者均高表达B系和T系相关抗原（100%,100%）.所有的B-ALL均不表达T-ALL相关抗原,所有T-ALL均不表达B-ALL相关抗原.CD13的表达率为31%（B-ALL31.4%,T-ALL 28.6%）.My＋B-ALL和My＋T-ALL患者的CD13阳性细胞的中位数高于My-B-ALL和My-T-ALL患者,P值分别为0.013和0.04.My＋B-ALL患者的CD15阳性细胞的中位数高于My-B-ALL患者,P=0.000 1.结论：白血病免疫分型对于白血病的诊断、治疗和预后判断均有很大帮助,其在临床诊断中的推广将有助于患者的诊断和治疗.CD13在My＋ALL中表达较高（31%）,白血病细胞在恶性演变过程中不同时期表现出特征反映,其临床意义有待于重新评价.     

成人急性淋巴细胞白血病免疫表型特点分析

目的研究成人急性淋巴细胞白血病(ALL)患者中不同亚型的各种白血病细胞免疫表型分布特点。方法采用当前国际通用的四色流式细胞术图像分析系统检测并综合分析76例ALL患者的免疫表型及其发生规律与特点。结果①76例ALL免疫表型系列来源可分为三种不同亚型,其中T-ALL亚型5例(占6.57%)、B-ALL亚型68例(89.48%)、T和B细胞混合型(T/B-ALL)亚型3例(3.95%)②ALL早期抗原表达特点:在B-ALL亚型中CD38、CD34、HLA-DR呈高表达;在T-ALL亚型中,CD38和CD34呈高表达,但HLA-DR不表达;在T/B-ALL亚型中,HLA-DR表达,CD34和CD38不表达。③按免疫分型相关抗原的敏感性和特异性分析:在B-ALL中,特异性抗原cCD79a占91.18%,敏感性抗原CD19表达占97.06%;在T-ALL中,特异性抗原cCD3和敏感性抗原CD7均表达为100%;在T/B混合型ALL中,cCD3、cCD79a、CD19均表达,CD7表达2例;④伴髓系抗原交叉表达分析:在B-ALL中,伴髓系抗原表达占21例(30.88%);在T-ALL中,伴髓系抗原表达1例(20%);T/...     

急性白血病细胞中CD19的表达

目的观察CD19在急性白血病(AL)中的表达与分布,为白血病的诊断、鉴别以及导向治疗提供依据.方法采用27个荧光直标单克隆抗体(单抗)及CD45/SSC双参数设门多色流式细胞术对321例AL细胞进行免疫诊断和分型,并对CD19在各类型AL细胞中的表达情况进行分析.结果在116例B细胞系急性淋巴细胞性白血病(ALL)患者中,CD19的阳性率(99.1%)明显高于B细胞系其它相关性抗原的阳性率;CD19在17例含B细胞系成分的杂合型白血病(HAL)中全部表达,而在29例T细胞系ALL和7例T/My HAL则均无表达;在152例急性髓系白血病(AML)中,仅11例(7.2%)CD19阳性,明显低于其在B细胞系ALL中的阳性率(P=0.001);CD22在B/My HAL的阳性率(12/15,80.0%)明显高于CD19 -AML(0/11,0%,P＜0.001).结论 CD19对B系ALL细胞的特异性较好,敏感性较高,是诊断B细胞系ALL较为可靠的表面标记,也可作为导向治疗B细胞系ALL的理想靶点.     

免疫分型对急性白血病诊断及预后诊断的意义

目的探讨免疫分型对急性白血病的分型诊断及预后诊断的价值。方法采用碱性磷酸酶抗碱性磷酸酶复合物(APAAP)法检测53例急性白血病患者的免疫分型。结果 免疫分型诊断急性髓系白血病(AML)27例,T淋巴细胞白血病(T-ALL)8例,B淋巴细胞白血病(B-ALL)10例,混合型自血病(ABL)6例,未分化型自血病(AUL)2例。T-ALL CD7阳性最常见,B-ALL CD19阳性最常见。AML中抗原表达依次为CD33>CD13>CD14>CD15,CD34/CD34/HLA-DR表达阳性率为64.2％。AML中阳性病例完全缓解率低于阴性病例。ABL及AUL治疗效果差。结论 白血病免疫分型可提高确诊率,并为预后判断提供依据。     

急性白血病免疫表型分析及其临床意义

 目的 探讨急性白血病（AL）的免疫表型特点及其临床意义。方法 采用间接免疫荧光法检测分析107例AL患者的免疫表型。结果 CD33、CD13是急性髓系白血病（AML）中最有诊断价值的指标,CD14有助于AML-M4、AML-M5与其他亚型的区别。CD2、CD7是T淋巴细胞白血病（T-ALL）中最有诊断价值的指标,CD19、CD22是B淋巴细胞白血病（B-ALL）中最有诊断价值的指标。17例ALL患者伴髓系抗原（My+ALL）表达率为11.76 %,85例AML患者伴淋系抗原（Ly+AML）表达率为24.71 %。My+ALL和My-ALL患者的CR率分别为0和71.43 %,差异无统计学意义（P＞0.05）。Ly+AML和Ly-AML患者的CR率分别为33.33 %和80.95 %,差异有统计学意义（P＜0.01）。CD+34 AML和CD-34 AML患者的CR率分别为40.74 %和83.33 %,差异有统计学意义（P＜0.01）。HLA-DR+AML和HLA-DR-AML的CR率分别为48.15 %和79.63 %,差异有统计学意义（P＜0.01）。结论 免疫表型分析对AL的诊断以及治疗指导、预后判断等均具有重要意义。     

成人急性淋巴细胞白血病免疫表型及细胞遗传学特征分析

目的：对110例成人急性淋巴细胞白血病（ALL）患者进行免疫表型及细胞遗传学特征分析.方法：采用CD45/SSC参数设门四色流式细胞术检测110例成人ALL患者治疗前骨髓细胞的免疫表型,染色体R显带技术对其中的73 例进行核型分析.结果：110例ALL患者中,21.8%为T-ALL,78.2%为B-ALL.47.3%的ALL患者表达髓系抗原 （MyAg）,CD13是成人ALL中最常见的MyAg （32.1%）.T-ALL髓系相关抗原表达总的阳性率（45.8%）与B-ALL（47.7%）无统计学差异.可供核型分析的73例中核型异常者37例（50.7%）,最常见的遗传学异常为Ph染色体,占23.3%.结论：免疫表型对ALL的诊断与分型至关重要,免疫表型与患者的异常核型改变及临床特征关系密切.     

71例急性白血病免疫表型特征分析及意义

目的:分析急性白血病(AL)免疫表型特点及其临床意义。方法:采用单克隆抗体直接免疫荧光标记法的流式细胞术,对71例AL进行免疫表型检测。结果:71例AL患者以系列专一型表达为主,同时亦存在抗原交叉表达、不表达特异性抗原及混合型等情况。AL患者CD34和HLA蛳DR表达分别占56.3 %和61.9 %,M3患者均不表达HLA蛳DR。My+ALL患者完全缓解(CR)率(60.0 %)低于My - ALL患者CR率(80.6 %),两组相比有显著性差异(P<0.05)。CD+34 ALL与CD蛳34 ALL患者缓解率基本相同;CD+34 AML患者CR率(58.3 %)明显低于CD蛳34 AML患者CR率(88.9 %),两组相比有显著性差异(P<0.05)。结论:白血病免疫表型检测结合FAB分型可以提高诊断的准确率,部分免疫表型特征对判断预后有一定的意义。     

Determination of Myloid Antigen Expression on Childhood Acute Lymphoblastic Leukaemia Cells: Discrepancies Using Different Monoclonal Antibody Clones

Prospective clinical studies including large numbers of patients have led to the conclusion that co-expression of myeloid antigens in childhood acute lymphoblastic leukaemia (My+ ALL) does not have prognostic significance. However, reports of the frequency of My+ ALL in children vary widely across laboratories using different mAb clones and staining and analysing procedures. Taking two commonly accepted thresholds of positivity for myeloid antigens (20 and 30%), we analysed the immunoreactivity of the most widely employed mAb clones against CD13 (SJ1D1, L138 and My7) and CD33 (My9, P67.6 and D3HL60) and compared the proportions of My+ ALL detected by these clones in childhood ALL. The correlation between myeloid antigen expression and the presence of the t(12;21) translocation was analysed concomitantly in the same samples.

The percentage of ALL cases positive for myeloid markers varied significantly depending on the mAb clone and the positive threshold. Among patients with B-ALL, the proportion of CD13+ ALL was significantly lower using SJ1D1 than using L138 or My7, while the proportion of CD33+ ALL was significantly higher for My9 than for P67.6 or D3HL60. Analysis of the co-expression of CD13 and CD33 on B-ALL cells using combinations of mAb clones showed that this frequency was either underestimated by the SJ1D1/D3HL60 or overestimated by the L138/P67.6 and My7/My9 combinations. A correlation between CD13/CD33 positivity and the t(12;21) translocation was uniformly observed in B-ALL patients for a positive threshold of 30%, whereas SJ1D1/D3HL60 detected no correlation between t(12;21) and CD13/CD33 ppositivity when the threshold was lowered to 20%. These data show that the mAb clones commonly used to detect the CD13 and CD33 surface antigens have variable immunoreactivity against childhood ALL cells, which may partly explain the conflicting reports concerning the prognostic significance of myeloid antigen expression in paediatric ALL and its association with different translocations. The present findings may also be of clinical importance for therapeutic choices.     

Determination of myeloid antigen expression on childhood acute lymphoblastic leukaemia cells: discrepancies using different monoclonal antibody clones.

Prospective clinical studies including large numbers of patients have led to the conclusion that co-expression of myeloid antigens in childhood acute lymphoblastic leukaemia (My+ ALL) does not have prognostic significance. However, reports of the frequency of My+ ALL in children vary widely across laboratories using different mAb clones and staining and analysing procedures. Taking two commonly accepted thresholds of positivity for myeloid antigens (20 and 30%), we analysed the immunoreactivity of the most widely employed mAb clones against CD13 (SJ1D1, L138 and My7) and CD33 (My9, P67.6 and D3HL60) and compared the proportions of My+ ALL detected by these clones in childhood ALL. The correlation between myeloid antigen expression and the presence of the t(12;21) translocation was analysed concomitantly in the same samples. The percentage of ALL cases positive for myeloid markers varied significantly depending on the mAb clone and the positive threshold. Among patients with B-ALL, the proportion of CD13+ ALL was significantly lower using SJ1D1 than using L138 or My7, while the proportion of CD33+ ALL was significantly higher for My9 than for P67.6 or D3HL60. Analysis of the co-expression of CD13 and CD33 on B-ALL cells using combinations of mAb clones showed that this frequency was either underestimated by the SJ1D1/D3HL60 or overestimated by the L138/P67.6 and My7/My9 combinations. A correlation between CD13/CD33 positivity and the t(12;21) translocation was uniformly observed in B-ALL patients for a positive threshold of 30%, whereas SJ1D1/D3HL60 detected no correlation between t(12;21) and CD13/CD33 positivity when the threshold was lowered to 20%. These data show that the mAb clones commonly used to detect the CD13 and CD33 surface antigens have variable immunoreactivity against childhood ALL cells, which may partly explain the conflicting reports concerning the prognostic significance of myeloid antigen expression in paediatric ALL and its association with different translocations. The present findings may also be of clinical importance for therapeutic choices.     

Determination of Myeloid Antigen Expression on Childhood Acute Lymphoblastic Leukaemia Cells: Discrepancies Using Different Monoclonal Antibody Clones

Prospective clinical studies including large numbers of patients have led to the conclusion that co-expression of myeloid antigens in childhood acute lymphoblastic leukaemia (My+ALL) does not have prognostic significance. However, reports of the frequency of My+ ALL in children vary widely across laboratories using different mAb clones and staining and analysing procedures. Taking two commonly accepted thresholds of positivity for myeloid antigens (20 and 30%), we analysed the immunoreactivity of the most widely employed mAb clones against CD13 (SJ1D1, L138 and My7) and CD33 (My9, P67.6 and D3HL60) and compared the proportions of My+ ALL detected by these clones in childhood ALL. The correlation between myeloid antigen expression and the presence of the t(12;21) translocation was analysed concomitantly in the same samples.

The percentage of ALL cases positive for myeloid markers varied significantly depending on the mAb clone and the positive threshold. Among patients with B-ALL, the proportion of CD13+ ALL was significantly lower using SJ1D1 than using L138 or My7, while the proportion of CD33+ ALL was significantly higher for My9 than for P67.6 or D3HL60. Analysis of the co-expression of CD13 and CD33 on B-ALL cells using combinations of mAb clones showed that this frequency was either underestimated by the SJ1D1/D3HL60 or overestimated by the L138/P67.6 and My7/My9 combinations. A correlation between CD13/CD33 positivity and the t(12;21) translocation was uniformly observed in B-ALL patients for a positive threshold of 30%, whereas SJ1D1/D3HL60 detected no correlation between t(12;21) and CD13/CD33 positivity when the threshold was lowered to 20%. These data show that the mAb clones commonly used to detect the CD13 and CD33 surface antigens have variable immunoreactivity against childhood ALL cells, which may partly explain the conflicting reports concerning the prognostic significance of myeloid antigen expression in paediatric ALL and its association with different translocations. The present findings may also be of clinical importance for therapeutic choices.     

Review of the incidence and clinical relevance of myeloid antigen-positive acute lymphoblastic leukemia

An increasing number of papers document cases of acute leukemia in which individual blast cells co-express markers normally restricted to a single cell lineage. Numerous terms are used to refer to cases with unscheduled expression of lineage-foreign proteins; the best defined categories were hybrid acute leukemia and acute mixed-lineage leukemia. The incidence of phenotypically variant acute leukemia varies with the quality and quantity of parameters used and the stringency of the criteria employed for its definition. Considerable interest has focused on acute lymphoblastic leukemia (ALL) cells expressing one or several myeloid lineage-associated antigens (My+ ALL), CD13, CD14, CD15, CD33, and CDw65. Owing to legitimate and cryptic expression on lymphoid cells, CD11b and CD15 reagents may not be considered as specific indicators of myeloid differentiation. The reported incidence ranged from 5 to 46% in 14 studies on My+ ALL, totalling 3817 patients. Several detailed reports documented a higher incidence of My+ ALL in adults (realistically in the range 10-20%) than in children (5-10%) and in B-lineage ALL as opposed to T-lineage ALL. My+ ALL cases are more likely to display unique cytogenetic [t(9;22), 11q23, 14q32] features than My-neg ALL. There appears to be no predominant expression of a single myeloid-associated antigen among those analyzed. As the morphological diagnosis of a leukemia subtype is often imprecise, some T-neg B-neg My+ ALL cases might actually contain FAB AML-M0 populations. While the expression of myeloid-associated antigens has no apparent prognostic significance in the majority of childhood ALL subtypes, in adults myeloid antigens seem to identify a high risk group of ALL patients with a poorer response to standard ALL therapy.     

成年人伴CD2表达B系急性淋巴细胞白血病免疫表型特征分析

 目的　了解成年人伴CD2表达B系急性淋巴细胞白血病（CD+2 B-ALL）的免疫表型特征,为临床诊断、治疗及预后判断提供依据。方法　应用流式细胞术及多种单克隆抗体检测18例成年人CD+2 B-ALL及68例CD-2 B-ALL患者的免疫表型,并对其结果进行分析比较。结果　CD+2 B-ALL的发病年龄明显小于CD-2 B-ALL,18例成年人CD+2 B-ALL的大部分表面标志物与CD-2 B-ALL相似,其中CD10表达水平[（73.78±26.67）%]高于CD-2 B-ALL[（52.84±35.25）%],差异有统计学意义（t＝2.35,P＜0.05）,CD33表达水平[（15.46±27.41）%]则低于CD-2 B-ALL[（31.15±27.72）%],差异有统计学意义（t＝2.16,P＜0.05）;所有B-ALL患者都高表达CD34,阳性表达率分别为72.2 %（13／18）和80.9 %（55／68）,差异无统计学意义（χ2＝0.64,P＞0.05）。CD+2 B-ALL的CD20阳性率明显低于CD-2 B-ALL,差异有统计学意义（χ2＝11.38,P＜0.05）。CD+2 B-ALL伴髓系抗原（CD13或CD33）表达率为44.4 %（8／18）,明显低于CD-2 B-ALL 的72.1 %（49／68）,差异有统计学意义（χ2＝4.86,P＜0.05）。结论　成年人CD+2 B-ALL与CD-2 B-ALL具有相似的免疫表型,主要来源于造血干细胞的恶性转化,CD+2 B-ALL伴髓系抗原（CD13、CD33）及CD20表达明显低于CD-2 B-ALL,提示成年人CD+2 B-ALL可能有较好的预后。