AML1-ETO融合蛋白致急性髓系白血病机制及靶向治疗

<正>AML1-ETO基因是急性髓系白血病(Acute Myeloid Leukemia,AML)中最常见的融合基因之一,由t(8;21)(q22;q22)染色体易位导致位于21q22上的AML1基因(又名RUNX1基因)与8q22上的ETO基因(又称为RUNX1T1或MTG8基因)融合而成[1],其表达产物为AML1-ETO融合蛋白。大约12%-15%的AML患者有t(8;21),90%的     

CD16+56在急性髓系白血病中的表达及其意义

为探讨CD16 56抗原在急性髓系白血病(AML)中的表达及其临床意义,本文用流式细胞仪检测42例AML患者的骨髓细胞,分析其细胞形态学(FAB)分型、免疫表型和临床特点。结果显示:42例AML患者中CD16 56阳性7例(16.6%),1例部分表达(2.4%),34例没有表达(80.9%)。CD16 56阳性的AML患者中,FAB分型、免疫表型和临床表现各有特点,多见于M2、M5,髓外浸润常见,大多数预后不良。     

急性髓系白血病淋系抗原的表达及其意义

<正>自1993年以来,我们用单克隆抗体(McAb)对40例急性髓系白血病(AML)的白血病细胞免疫表型进行了检测.1 材料和方法1.1 病例和标本 40例AML均系我院住院患者,都为初发病例;男性21例,女性19例;年龄13～71岁;按FAB分型标准,M_16例,M_2.9例,M_39例,M_47例,M_5 9例.检测标本多数为化疗开始前抽取的骨髓,少数为外周血.1.2 检测方法 间接免疫荧光法,荧光阳性细胞≥0.20作为阳性指标.实验中采用的McAb有:CD2、CD3、CD4、CD7、CD8、CD10、CD11b、CD13、CD14、CD15、CD19、CD20、CD22、CD33、CD34、CD41b、HLA-DR、μ、SmIg等.McAb分别购自军事医学科学院和中国医学科学院血液学研究所.     

急性髓系白血病血管内皮生长因子表达与预后的研究

目的 :观察人白血病细胞系血管内皮生长因子 (VEGF)表达水平 ,研究急性髓系白血病 (AML)患者血清VEGF表达水平与预后的关系。方法 :采用酶联免疫吸附法 (ELISA)对 4 9例初治、10例复发AML患者血清及人白血病细胞系U937、K5 6 2、HL - 6 0、TF - 1和NB4培养上清液 (4 8小时 )VEGF表达水平进行检测。结果 :五种人白血病细胞系培养上清液中均测到VEGF高表达。 4 9例初治、10例复发AML患者的血清VEGF表达水平分别为 2 0 1 17± 110 93pg ml和 2 32 5 9± 118 6 2pg ml,均明显高于正常对照组 (12 5 6 2± 4 5 4 3pg ml;p <0 0 5 )。初治AML患者中VEGF高表达组 (>2 0 1 17pg ml)完全缓解 (CR)率为 4 8% ,低表达组 (<2 0 1 17pg ml)CR率为 77% ,两者比较差异显著 (p<0 0 5 )。结论 :血管内皮生长因子在刺激白血病细胞增殖、迁移中发挥重要作用。AML患者血清VEGF水平与预后具相关性     

CD7阳性在急性髓细胞白血病中表达的临床意义

随着系列单克隆抗体的应用,白血病细胞免疫分型的广泛开展及其研究的深入,伴有CD7抗原表达的急性髓细胞白血病（CD7^＋AML）不断被发现。认为CD7^＋AML是一类独特的急性髓细胞白血病亚型,具有与不伴有CD7抗原表达的急性髓细胞白血病（CD7^-AML）不同的临床特点、生物学特征与预后。     

PD-L1在急性髓系白血病中的表达及临床意义

目的 探究程序性死亡分子1配体-1（PD-L1）在急性髓系白血病（AML）中的表达作用和临床意义。方法 选取2013年1月~2016年12月在我院进行治疗并确诊为AML的初治患者49例为观察组,选择同期在我院接受治疗的27例非恶性疾病如缺铁性贫血、巨幼细胞性贫血者作为对照组。对比两组患者血液中的PD-L1表达水平,分析患者性别、年龄、初诊白细胞计数、亚型的对血液中PD-L1的影响,确定PD-L1表达与临床疗效的相关性。结果 对照组患者治疗前的PD-L1表达与观察组比较,差异无统计学意义（P＞0.05）。治疗后,观察组的PD-L1表达高于对照组,统计学意义显著（P＜0.01）。单因素结果显示,PD-L1在AML初诊患者中的表达水平与患者的性别、年龄、初诊WBC数、分型无相关性（P＞0.05）;未缓解AML患者组PD-L1表达水平高于持续完全缓解组AML患者（P＜0.01）。结论 PD-L1可能参与AML的免疫逃逸机制,并可能与病情进展及治疗效果相关。     

急性髓系白血病中CD64表达的敏感性及特异性研究

研究急性髓系白血病(AML)免疫分型中CD64的敏感性和特异性.用系列抗原对132例AML患者的骨髓细胞进行直接标记,并用流式细胞术进行分析.结果表明:在AML中,CD64对急性粒-单细胞白血病(M4)和急性单核细胞白血病(M5)中敏感性最高(分别为96.4%和100%),在其他AML(M0、M1、M2、M3,M6、M7)中表达均较低.CD64对M4和M5中的特异性为56.5%.因此,CD64有助于AML中M4、M5的鉴别诊断.     

急性髓系白血病干细胞研究进展

急性髓系白血病干细胞多数亚型的干细胞具有相似的免疫表型(CD34+、Cd38-、CD90-、CD117-、CD123+),表达核因子NF-KB。急性髓系白血病干细胞对化疗和放疗均不敏感,是急性髓系白血病复发的原因之一。选择急性髓系白血病干细胞高表达的抗原CD123或核因子NF-KB,作为清除急性髓系白血病干细胞或诱导急性髓系白血病干细胞凋亡的标记,是探索彻底治愈急性髓系白血病的最佳途径。     

急性髓系白血病细胞血管细胞黏附分子1、CD34和CD117的表达

背景：血管细胞黏附分子1与白血病浸润密切相关,白血病细胞本身是否表达血管细胞黏附分子1,以及与疾病难治是否相关尚无定论。 目的：分析血管细胞黏附分子1、CD34、CD117在急性髓系白血病细胞表面的表达,3者之间的相互关系及与难治性急性髓系白血病的相关性。 方法：采用流式细胞技术检测16例急性髓系白血病细胞中血管细胞黏附分子1、CD34、CD117的表达,其中难治组6例,非难治组10例;同时以正常骨髓单个核细胞标本作对照。 结果与结论：急性髓系白血病细胞CD34、CD117表达高于对照组(P < 0.05)。难治组急性髓系白血病细胞CD34表达明显高于非难治组(P < 0.05)。难治组与非难治组CD117表达差异无显著性意义(P > 0.05)。急性髓系白血病细胞血管细胞黏附分子1表达与对照组比较差异无显著性意义(P > 0.05)。难治组与非难治组血管细胞黏附分子1表达差异无显著性意义(P > 0.05)。表明急性髓系白血病细胞伴CD34表达,为不良预后指标之一,CD117、血管细胞黏附分子1表达与其是否难治无明显相关性。     

Immunophenotypic profile predictive of KIT activating mutations in AML1-ETO leukemia

Translocation (8; 21)/AML1-ETO is considered a favorable cytogenetic abnormality in acute myeloid leukemia (AML). However, associated KIT activating mutations confer poor outcome. The immunophenotype associated with KIT mutations in AML1-ETO has not previously been elucidated. We retrospectively reviewed the immunophenotype by flow cytometry of 56 cases of AML with t(8; 21) and compared them with 100 cases of AML without t(8; 21). In 21 t(8; 21) cases, we sought KIT mutations by direct sequencing. Although CD19 and CD56 were aberrantly expressed in 42 (75%) of 56 and 46 (82%) of 56 cases, respectively, with t(8; 21), these markers were only expressed in 4% and 25%, respectively, without t(8; 21) (P < .001). However, the 5 KIT-mutated cases (D816H, 3; D816Y, 1; and N822K, 1) of t(8; 21) AML had diminished CD19 expression (P = .04) with definite CD56 expression (P = .30) on myeloid blasts. Our study suggests that KIT activating mutations in AML with t(8; 21) are associated with diminished CD 19 and positive CD56 expression on leukemic blasts and, thus, can be phenotypically distinguished from AML1-ETO leukemias without KIT mutations.     

The clinical significance of karyotype in acute myelogenous leukemia

To evaluate further the prognostic significance of karyotype at diagnosis of acute myelogenous leukemia (AML), we have made a follow-up study of 711 patients who were diagnosed between January 1, 1980, and March 31, 1982, and who were originally reported by the Fourth International Workshop on Chromosomes in Leukemia (4IWCL). Three different chromosomal classifications were evaluated, including presence of normal and abnormal metaphases (NN-AN-AA classification), a modification of the Chicago classification, and a complexity classification. All three chromosomal classifications were shown to correlate significantly with outcome in patients with de novo AML. Furthermore, the NN-AN-AA classification and the complexity classification had independent prognostic significance when age, sex, and FAB morphology were also considered in multivariate analyses of survival. These data provide further evidence that karyotype is an important factor in predicting the outcome of patients with AML.     

AML1 amplification in a child with acute lymphoblastic leukemia

We report a case of de novo acute lymphoblastic leukemia with tandem amplification of the AML1 gene located in a chromosome marker that originated from chromosome 21 and a long event-free survival.     

Expression and significance of CD47, PD1 and PDL1 in T-cell acute lymphoblastic lymphoma/leukemia

Although dose intensi?cation strategies achieve a favorable prognosis for pediatric patients of T-lmphoblastic lymphoma/leukemia (T-LBL/ALL), numerous side effects have been followed. Molecular targeted therapies will be needed to optimize the current treatment strategy for T-LBL/ALL. The aim of this study was to analyse expression and significance of CD47, PD1 and PDL1?in. T-LBL/ALL. We performed immunohistochemistry staining and real time fluorescence quantitative PCR (qRT-PCR) on FFPE tissues. Immunohistochemistry results showed that the high expression rate of CD47 protein was 46.4% (26/56) and the positive expression rate of PDL1 protein was 37.5% (21/56). PD1 expression was observed in tumor infiltrating lymphocytes in approximately 20% of T-LBL/ALL patients, but not expressed on tumor cells of T-LBL/ALL. And the results of qRT-PCR showed that the relative expression levels of CD47, PDL1 and PD1 mRNA in 56 cases of T LBL/ALL were significantly higher than those in control group (6.915 vs 4.050, 12.255 vs 2.575, 37.990 vs 3.615), and the differences were all statistically significant (p all <0.05). Univariate analysis showed that age, CD47 protein, CD47 mRNA,PDL1 protein and PDL1 mRNA expression were closely correlated with prognosis (P all <0.05). We found that the overall one-year survival rates of patients with a high expression (≥M) of CD47 and PDL1 mRNA were higher than in patients with low expression (<M). However, the overall one-year survival rate of patients with a high expression (≥M) of CD47 and PDL1 protein were lower than in patients with low expression (<M). And patients with ≤25 years old had a worse prognosis than with >25 years old. Multivariate Cox regression analysis showed that the high expression of CD47 and PDL1 protein were independent prognostic factors (both p?<?0.05). In a word, PD1/PDL1 and CD47 may be involved in the disease progression and prognosis of T-LBL/ALL, and detection and targeting of CD47 and PD1/PDL1 may provide a rational basis to for treatment of T-LBL/ALL.     

217例成人急性淋巴细胞白血病遗传学特征及其临床预后意义的研究

目的 研究成人急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)的细胞和分子遗传学特征及其临床预后意义.方法 通过常规细胞遗传学、荧光原位杂交、实时定量多聚酶链反应、巢式PCR扩增及测序等技术相结合,对217例成人ALL患者细胞及分子遗传学特征全面分析,并探讨其临床预后意义.结果 成人ALL遗传学异常以t(9;22)(q34;q11)/ BCR-ABL融合基因最常见(56.3％),其次为复杂核型(13.8％),其它异常占29.9％;经荧光原位杂交确诊BCR/ABL融合基因阳性患者中22.4％经常规细胞遗传学检测未发现Ph染色体;遗传学预后分组高危组患者随年龄增大递增;高危组B-ALL亚型高于标危组(98.4％ vs.65.7％,P=0.000),高危组3个月(67.3％ vs.85.1％,P=0.042)、6个月(55.1％vs.80.4％,P=0.008)、12个月(34.0％ vs.59.1％,P=0.017)和24个月(13.0％ vs.36.6％,P=0.010)总生存(overall survival,OS)率均显著低于标危组,中位OS时间高危组(11个月,95％CI:8.0～13.9)比标危组(19个月,95％CI:10.8～27.1)显著缩短(P=0.001).结论 成人ALL具有特征性遗传学异常,本组预后分组对判断患者预后、指导临床正确分层治疗具有一定临床意义.临床上单独应用常规细胞遗传学检测漏诊率高,建议常规细胞遗传学检测、荧光原位杂交技术和分子生物学技术相结合,提高细胞及分子遗传学亚型的正确诊断水平.     

Cytogenetic studies of 103 patients with acute myelogenous leukemia in relapse

In order to investigate the cytogenetic patterns in relapsed acute myelogenous leukemia (AML), a clinical and cytogenetic follow-up of patients newly diagnosed for the Fourth International Workshop on Chromosomes in Leukemia (4IWCL) was evaluated at the 6IWCL. Information was received on 103 patients in relapse who were then classified into seven groups according to the diagnostic karyotype. These groups were: normal, t(8;21), t(15;17), +8, a single specific abnormality either numerical or structural other than those already listed, a single nonrandom or miscellaneous abnormality again either numerical or structural, and complex abnormalities. The patient's age, diagnostic FAB type, the number of relapses, the total survival time, and the karyotype in relapse were considered in each of these cytogenetic groups. The remission and survival rates were comparable in all groups except the +8 group, where patients relapsed earlier and had a shorter survival time. Multiple relapses occurred most frequently in the t(8;21) group, whereas none of the patients with t(15;17) relapsed more than once, although the total survival time was similar in the two groups. Thirty-nine percent of the patients relapsed with the same karyotype as at diagnosis. A more complex karyotype showing evolution was found in 53%, and 8% showed either a less-complicated karyotype or appeared to have reverted to normal. Numerical abnormalities in relapse frequently involved trisomy of chromosomes 8 and/or 21. There was a nonrandom development of 9q− with relapse in patients with t(8;21). A pericentric inversion of chromosome 4, an abnormality infrequently reported at diagnosis, was found in relapse in association with t(15;17), t(8;21), and +8 karyotypes. Changes considered to be typically secondary in nature involving 5q, 7q, and 12p were seen in only seven cases. Twenty-one patients who had an apparently normal karyotype at diagnosis remained normal in relapse, indicating that absence of clonal chromosome abnormality is a real observation in AML rather than a failure of detection.     

急性早幼粒细胞白血病中CD117和CD34共表达的临床意义

目的：研究CD117和CD34在成人急性非淋巴细胞自血病（Acute nonlymphoblastic leukemia，ANLL）M1～M2型和急性早幼粒细胞白血病（Acute promyelocytic leukemia，arE）M3患者中的表达，重点探讨M3患者CD117和CD34共表达（CD117／CD34共表达）的临床意义。方法：将研究病例分为M1～M2和M3二组，采用流式细胞术（Flow cytometery，FCM）随机检测54例M3和63例M1～M2二组初诊患者骨髓单个核细胞（BMMNC）髓系抗原CD117和干（祖）细胞抗原CD34的表达；比较M1～M2和M3二组ANLL患者中CD117、CD34表达的阳性率的差异，以及CD13、CD33和CD117分别与CD34共表达的阳性率差异。结果：CD117在M1～M2组患者中表达的阳性率是71．4／％（45／63），在M3组表达的阳性率为66．7％（36／54），差异无统计学意义（P=0．58）；CD34在M1～M2和M3二组中表达的阳性率分别为66．7％（42／63）和11．1％（6／54），差异有统计学意义（P=0．000）；二组ANLL的CD117／CD34共表达阳性率分别为71．1％（45／63）和7．4％（4／54），其差异有统计学意义（P=0．000）。结论：CD117可作为AL的髓系免疫学标志，但其在ANLL中的表达缺乏系列内阶段特异性。M3患者的CD34表达和CD117／CD34共表达的阳性率低于M1～M2者；CD117／CD34共表达可作为M1～M2和M3鉴别诊断的免疫学分型参考指标。     

Chromosome 21 abnormalities with AML1 amplification in acute lymphoblastic leukemia

Fluorescence in situ hybridization (FISH) studies were performed in three cases of acute lymphoblastic leukemia (ALL) with marker chromosomes to analyze the contribution of chromosome 21 in these markers. FISH with a chromosome 21 painting probe confirmed that chromosome 21 was involved in all three cases. FISH with YAC probes showed that the number of extra copies varied according to their location on chromosome 21. Attention was focused on the AML1 gene, which was present as five copies in most of the cells exhibiting the marker chromosomes. As controls, 11 cases of childhood ALL were studied with PAC probes covering AML1. The results agreed with the banded karyotypes in 10 patients. FISH uncovered a clone with four copies of AML1 which were only observed by FISH analysis of interphase nuclei in one patient. No point mutation was detected in exons 3-5, encoding the runt domain of AML1, in the three cases, suggesting an oncogenic role of wild-type AML1 amplification.