急性淋巴细胞白血病免疫分型的特点及其临床意义

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.     

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.     

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.     

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.     

成人急性白血病中CD117与CD34共表达的临床意义

背景与目的:c-kit受体(c-kitreceptor,c-kitR,CD117)是干细胞因子受体。CD117在急性非淋巴细胞白血病(acutenon-lymphoblasticleukemia,ANLL)中高表达,可作为髓系免疫学标记物,对诊断ANLL有一定参考价值。但是,CD117也可在部分急性淋巴细胞白血病(acutelymphoblasticleukemia,ALL)中表达。CD34为造血干(祖)细胞抗原标记物,在ANLL和ALL中均有高表达。本研究旨在探讨CD117和CD34在急性白血病中共表达的临床意义。方法:采用流式细胞术(flowcytometery,FCM)分别检测92例ALL和81例ANLL初诊患者骨髓单个核细胞(BMMNC)CD117的阳性率和阳性细胞水平;比较ALL和ANLL患者CD117/CD34共表达率的差异,并比较ALL患者中CD117和CD117/CD34共表达率的差异。设立20例健康成人为对照组。结果:在ALL和ANLL患者中CD117阳性率分别为15.2%和71.6%,CD117/CD34共表达率分别为5.4%和55.5%,差异有显著性(P<0.001)。ALL患者中CD117表达率和CD117/CD34共表达率分别为15.2%和5.4%,差异有显著性(P=0.029)。结论:CD117可作为急性白血病的MIC分型诊断之髓系免疫学标志,用以协助ANLL的临床诊断;较之CD117表达,CD117/CD34在ALL中的共表达率更低,可籍此协助排除ALL。     

Acute leukemia expressing the normal human hematopoietic stem cell membrane glycoprotein CD34 (MY10)

Thirty-one cases of acute leukemia with blast cells greater than or equal to 70% positive for the hematopoietic stem cell Ag, CD34 (MY10, HPCA-1), were identified from the University of Nebraska Medical Center and The Johns Hopkins Oncology Center over an 18-month period. Fourteen of the cases were classified as early B-lineage ALL, 3 cases were other ALL subtypes, and 14 of the cases were ANLL. Five of the 17 cases of ALL expressed one or more myeloid-associated surface Ags, 3 ANLL cases expressed CD10 (CALLA, J5), and T-lymphoid Ags were present in 12 of 31 cases (1 T-cell ALL, 3 of 16 B-lineage ALL cases, and 8 of 14 ANLL cases). Eleven of 12 CD34+ ALL cases studied had abnormal karyotypes; only 7 of 12 CD34+ ANLL cases studied had abnormal karyotypes, and 3 of these were CD10+ ANLL. Six cases were Ph1 positive, including the one mature B cell ALL, 4 early B-lineage ALL, and 1 CD10+ ANLL case. Good and poor prognosis subgroups of high frequency of expression of CD34 leukemias could be identified, generally, as would have been predicted by previously defined criteria. Thus, of the 10 Ph1-negative early B-lineage ALL patients, 9 achieved CR (90%). At the other extreme, the CR rate of CD10- ANLL was 4 of 11 (36%). The leukemias characterized by greater than or equal to 70% of cells positive for CD34 form a relatively undifferentiated subset of the leukemias which may show features associated with more than one lineage, and if CD10- and myeloid morphology, may respond poorly to therapy.     

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。     

In vivo and in vitro expression of myeloid antigens on B-lineage acute lymphoblastic leukemia cells.

The expression of myeloid antigens has been extensively examined using two-color analysis in 43 children with B-lineage acute lymphoblastic leukemia (ALL). On pre-culture cells, CD33 expression was frequently observed in CD19+, CD10- B-precursor ALL, and CD14 was expressed only on the cells from B-precursor ALL expressing CD19, CD10 and CD20, and B-ALL. After 2 or 3 days of culture without TPA, CD13 emerged on the cells from 21 of 29 patients irrespective of the presence or the absence of fetal calf serum in the culture. Of four patients with CD10+ B-precursor ALL, which showed no expression of CD13 after culture, two had T-cell associated antigens. Whereas the addition of TPA to the culture enhanced the expression of CD13 on the cells from acute non-lymphocytic leukemia (ANLL), TPA reduced the expression of this antigen on B-precursor cells. These findings suggest that the regulatory mechanism of CD13 expression may be different between B-precursor ALL and ANLL. Co-culture with cycloheximide mostly abrogated the induction of CD13, suggesting that CD13 expression was mainly dependent on de novo protein synthesis.     

CD45设门多参数流式细胞术在急性白血病免疫表型分析中的应用

目的：分析急性白血病的抗原表达及其临床意义。方法：采用一组系列相关单抗直接免疫荧光标记CD45设门的多参数流式细胞术,检测35例急性白血病患者的免疫表型。结果：11例ALL中B－ALL8例,T－ALL3例,其中出现髓系抗原表达4例,占36．4％,CD34表达10例,占90．1％;24例AML中伴淋系抗原表达7例,占29．17％,CD34表达16例,占70．8％,DR的表达与CD34一致,5例M3患者均无CD34和HLA DR表达。伴髓系统原表达的ALL CR率低于髓系抗原阴性表达者（1／3及5／6）,但统计学上差异无显著性（P＞0．05）;伴淋系抗原表达的AML患者CR率明显低于淋系抗原阴性表达者（0／5及10／10）,两组间差异具有显著性（P＜0．01）。结论：CD45设门的多参数流式细胞术是分析白血病免疫表型的最好方法,白血病抗原的错义表达是预后不良的因素之一。     

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.