139例急性髓系白血病免疫分型特点分析

目的探讨急性髓性白血病（AML）的免疫分型特点及意义。方法采用单克隆抗体和流式细胞仪检测AML的免疫表型。结果（1）139例AML病例中各种抗原的阳性表达率依次为为MPO（92.1%）,CD33（92.1%）,CD13(89.2%),其中53例AML伴淋巴系抗原表达,分别为CD19(20.9%),CD7(16.2%),CD2(7.2%),CD10(0.72%)。(2)CD14在M4、M5型AML中高表达。(3)干祖细胞分化抗原表达率依次为CD117（83.8%）〉HLA DR(80.3%)>CD34(67.6%),CD34阳性的完全缓解率（CR）分别明显低于CD34阴性组（P=0.034）。（4）CD7阳性患者CR明显低于其抗原表达阴性者（P=0.041）。结论白血病免疫分型能确诊某些特殊类型的白血病,对免疫分型的研究将有助于指导临床诊断、治疗及判断预后。     

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。     

CD117在急性白血病中的表达及其临床意义

 目的 探讨细胞表面抗原CD117在各型急性白血病（AL）中的表达规律及其临床意义。方法 采用流式细胞术（FCM）检测139例AL患者骨髓或外周血中CD117的表达情况,并进行分析和比较。结果 急性淋巴细胞白血病（ALL）患者CD117阳性细胞表达水平与正常对照组相比差异无统计学意义（P＞0.05）;急性髓细胞白血病（AML）患者CD117阳性患者比例及阳性细胞表达水平较正常对照组和ALL组均升高,差异有统计学意义（均P＜0.05）。在AML各亚型中,CD117阳性患者比例及阳性细胞表达水平以M0／M1最高,M5b最低;在5种髓系膜抗原标志中,虽然CD117检测AML的灵敏度低于CD13和CD33,但特异性都较高;CD117与CD34及HLA-DR在AML中的表达呈显著正相关,但在M3中,CD117表达明显高于CD34和HLA-DR。结论 CD117可作为AL患者MIC诊断分型的重要髓系免疫表型指征,在AML的诊断分型以及AML和ALL的鉴别诊断中具有重要意义。     

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。     

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。     

急性髓系及混合型白血病流式细胞术免疫分型检测结果

 目的　研究流式细胞术（FCM）检测在急性髓系白血病（AML）及混合型白血病（MAL）诊断中的意义。方法　采用四色FCM对52例AML和7例MAL患者进行免疫表型检测。结果　52 例AML患者以系列专一表达为主,主要表达 CD13（94.2 %）,CD117（90.4 %）,cMPO（90.4 %）CD33（86.5 %）,CD34（57.7 %）,HLA-DR（53.8 %）。7例MAL中髓系／B系（M／B）混合3例,均表达CD13,CD34,CD117,CD10,CD19,cMPO,cCD79a;髓系／T系（M／T）混合2例,均表达CD13,CD117,CD33,CD34,CD5,CD7,cMPO;B系／T系（B／T）混合2例,均表达CD5,CD7,CD10,CD19,CD20,CD34。且与形态学和组织化学诊断具有高符合率。结论　FCM能够提高AML和MAL的确诊率,对该类白血病的明确诊断及分型具有重要的临床指导意义。     

成人急性髓系白血病的免疫学特点及预后

目的：探讨急性髓细胞白血病（AML）的免疫表型特点。方法：使用淋系和髓系单抗,用间接免疫荧光法对70例原发性AML进行免疫表型分析。结果：所有AML患者的细胞至少被1种髓系单抗标记,各髓系抗原的表达率依次为CD33＞CD13＞CD15。所有M3患者CD9为阳性。16／70例（30％）表达CD34抗原、CD34^ AML组在年龄、外周血象及骨髓原始、幼稚细胞比例等方面与CD34^-组相比较无显著差别,但表达CD34抗原的AML常伴有HLA－DR、CD38、CD7等不成熟细胞表面标记的表达,而较成熟的髓系细胞表面标记CD15则不表达。70例AML中有16例表达淋系抗原,CD4^ 例（13．8％,M2为8．8％,M460％）;CD7^ 9例（16．9％,M1为50％,M218％,M5b16．7％）。CD4^ 的AML患者CD34为低表达,CD33表达。结论：CD9^ 、CD34^-、HLA－DR^-及CD13^ 、CD15^ 是典型M3的免疫表型特点。CD34^ AMLgn AML-M1有着密切的关系,且对化疗反应较差,证明CD34^ 的AML是一组分化程度较差的类型;提示CD7^ 和CD4^ 的AML预后差,CD7^ 的AML的一种独特类型。     

35例急性白血病免疫表型特征

 目的 分析急性白血病（AL）免疫表型诊断意义并对急性白血病各亚型CD抗原表达进行比较。方法 对35例AL患者进行形态学检查,并用流式细胞仪检测白血病细胞免疫表型。结果 35例AL患者中,形态学分型：急性髓细胞白血病（AML）M1 2例,M2 4例,M3 6例,M4 7例,M5 8例,不能分型AL 1例,急性混合细胞白血病1例,急性淋巴细胞白血病（ALL）L1 4例,L2 2例。免疫表型检查结果在AML各亚型中CD13、CD33、MPO均阳性,CD+34 18例,CD+14 5例。其中2例伴有CD+19,6例ALL患者中,CD19、CyCD79a均阳性,CD+10 4例,CD+20 2例,1例不能分型AL表达CD10、CD19、CD34、CyCD79a诊断为B-ALL,1例混合细胞白血病有淋系和髓系表达,故诊断为混合细胞白血病。结论 白血病免疫表型检测能使AL的诊断率提高,因此对形态无法鉴别的AL,应进一步进行免疫表型检测。     

新疆地区450例急性白血病的免疫分型研究

 目的　研究新疆地区急性白血病（AL）患者免疫表型分布特点。方法　采用间接免疫荧光法对450例AL患者进行免疫表型分析。结果　106例急性淋巴细胞白血病（ALL）,334例急性髓系白血病（AML）,10例为FAB不能分类的急性白血病（UAL）;ALL中髓系抗原的表达15 %,AML中淋系抗原的表达25 %,表达最频繁的是CD7;研究了295例AL患者MPO mRNA基因表达,81例ALL中有1例表达MPO基因;所有髓系均不同程度地表达MPO基因,9例UAL有6例表达MPO基因;ALL免疫分型特点在汉族和维吾尔族（简称维族）中差异无统计学意义（P＞0.05）,在AML中,汉族髓系抗原的表达率依次为CD33＞CD13＞CD15,维族髓系抗原的表达率依次为CD15＞CD33＞CD14。结论　免疫表型的检测对AL更精确地诊断和分型有重要意义。联合分析AL形态学、细胞化学、免疫学及MPO mRNA表达等特点,对于AL的诊断和指导治疗均有重要意义。     

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。     

112例淋巴系统恶性肿瘤骨髓免疫表型分析

背景与目的:淋巴细胞白血病和淋巴瘤骨髓侵犯的诊断以细胞形态学为基础,而免疫分型可通过获得肿瘤细胞分化和发育阶段的信息使淋巴系统恶性肿瘤的诊断更为准确,为临床合理治疗和预后判断提供重要的科学依据.本研究应用多参数流式细胞术(flow cytometry,FCM)探讨淋巴细胞白血病和非霍奇金淋巴瘤(non-Hodgkin's lymphoma,NHL)骨髓侵犯的免疫表型特点.方法:收集112例病理确诊NHL并伴骨髓侵犯和淋巴细胞白血病患者的骨髓标本.应用FCM检测肿瘤细胞的免疫表型.结果:45例前驱B淋巴母细胞白血病/淋巴瘤(precursor B lymphoblastic lymphoma/leukemia,B-ALL/LBL)主要表达CD19、CD10、TdT、CD34、HLA-DR和CD20;32例前驱T淋巴母细胞白血病/淋巴瘤(precursor T lymphoblastic lymphoma/leukemia,T-ALL/LBL)主要表达胞内CD3(cytoplasmic CD3,CyCD3)、CD7、CD5、TdT、膜表面CD3(surface CD3,sCD3)和HLA-DR.77例前驱淋巴细胞肿瘤中,28例(36%)有髓系抗原CD13、CD33的表达;9例(20%)B-ALL/LBL病例有CD20与CD34共同表达,28例(87.5%)T-ALL/LBL病例有CyCD3与TdT共同表达.成熟淋巴细胞肿瘤35例,其中17例慢性淋巴细胞白血病/小淋巴细胞淋巴瘤主要表达CD19、CD20、CD5和HLA-DR,并有CD19与CD5共同表达.4例弥漫大B细胞性淋巴瘤主要表达CD19、CD20、CD10和HLA-DR.3例伯基特淋巴瘤主要表达CD19、CD10、CD20、SIgM.1例套细胞淋巴瘤表达CD5、CD19、CD20、HLA-DR.5例外周T细胞淋巴瘤(PTCL)主要表达sCD3、CD5、CD7、CD4或CD8.1例间变性大细胞淋巴瘤主要表达sCD3、HLA-DR.4例NK/T细胞肿瘤表达CD56、HLA-DR,也表达CD7或CD4或CD8.成熟淋巴细胞肿瘤不表达早期抗原如CD34、TdT.成熟淋巴细胞肿瘤可伴有髓系抗原CD13、CD33的表达.结论:淋巴系统恶性肿瘤侵犯骨髓采用形态学结合FCM免疫学分型可获得T、B细胞来源、肿瘤细胞分化阶段和异常抗原表达等参数,有助于临床诊断和微小残留病灶的检测.     

Minimally differentiated acute myelogenous leukemia (AML-M0) granulocytic sarcoma presenting in the oral cavity

Acute myelogenous leukemia with minimal differentiation (AML-M0) is a rare subtype of acute leukemia in which blasts fail to show morphologic differentiation and conventional cytochemical stains and myeloid markers are negative. Acute myelogenous leukemia (AML) presents primarily with peripheral blood and/or bone marrow involvement. Presentation in extramedullary sites, including the head and neck region, is not uncommon. Acute myelomonocytic leukemia (AML-M4) and acute monocytic leukemia (AML-M5) have had the highest incidence of associated oral infiltrates. We report a case of a 58-year-old gentleman, with no prior history of acute leukemia, presenting with a solitary palatal swelling. Initial morphologic examination favored high-grade non-Hodgkin's lymphoma (NHL). Conventional cytochemical and immunohistochemical stains were negative for lymphoid and myeloid markers. Subsequent immunophenotyping via flow cytometry performed on peripheral blood and bone marrow aspirate demonstrated myeloid lineage without lymphoid differentiation, confirming the diagnosis of AML-M0.To our knowledge, this subtype of AML-M0 has not been previously reported involving the oral cavity. With absence of morphologic differentiation, and negative findings on conventional cytochemical and immunohistochemical stains, this subtype of leukemia may be misdiagnosed as non-Hodgkin's lymphoma (NHL). Flow cytometry is useful in detecting the myeloid lineage of this leukemia.     

Haematologic and immunophenotypic profile of acute myeloid leukemia: an experience of Tata Memorial Hospital

OBJECTIVES: To study the hematologic and immunophenotypic profile of 260 cases of acute myeloid leukemia at diagnosis. MATERIAL AND METHODS: This is a retrospective analysis of 260 cases of AML diagnosed at our institution between 1998 and 2000. Diagnosis was based on peripheral blood and bone marrow examination for morphology cytochemistry and immunophenotypic studies. SPSS software package, version 10, was used for statistical analysis. RESULTS: Seventy-six percent of our cases were adults. The age of the patients ranged from one year to 78 years with a median age of 27.2 years. There were 187 males and 73 females. The commonest FAB subtype, in both children and adults, was AML-M2. The highest WBC counts were seen in AML-M1 and the lowest in AML-M3 (10-97 x 10(9)/L, mean 53.8 x 10(9)/L). The mean values and range for hemoglobin was 6.8 gm/l (1.8 gm/l to 9.2 gm/l), platelet count 63.3 x 10(9)/L (32-83 x 10(9)/L), peripheral blood blasts 41.4% (5 to 77%) and bone marrow blasts 57.6% (34-96%). Myeloperoxidase positivity was highest in the M1, M2 and M3 subtypes. CD13 and CD33 were the most useful markers in the diagnosis of AML. CD14 and CD36 were most often seen in monocytic (38%) and myelomonocytic (44%) leukemias. Lymphoid antigen expression was seen in 15% of cases. CD7 expression was the commonest (11%). CONCLUSION: AML accounted for 39.8% of all acute leukemias at this institution. The most common subtype was AML-M2. Myeloperoxidase stain was a useful tool in the diagnosis of myeloid leukemias. CD13 and CD33 were the most diagnostic myeloid markers.     

多参数流式细胞术在淋巴细胞白血病和非霍奇金淋巴瘤骨髓侵犯诊断的应用

背景与目的：骨髓形态学检查可诊断淋巴细胞白血病,结合淋巴结活检可诊断非霍奇金淋巴瘤(non—Hodgkin‘s lymphoma,NHL)侵犯骨髓,但形态学仅是初步的诊断,采用免疫分型而获得肿瘤细胞来源及发育阶段的资料是目前诊治淋巴系统恶性肿瘤所必需的。本研究探讨多参数流式细胞术(flow cytometry,FCM)在淋巴细胞白血病、NHL骨髓侵犯的诊断和免疫分型方面的应用价值。方法：取初治白血病患者骨髓标本11例和NHL患者骨髓侵犯的骨髓标本41例,以及2例分别表现为巨大纵隔肿块和腹部巨大肿块的患者因无法取得病理标本而取骨髓检测的骨髓标本2例。采用B细胞系列抗体、T细胞系列抗体、粒细胞系列抗体,按常规行FCM免疫表型检测,CD45结合两个系列单抗或阶段特异性单抗进行三色免疫荧光染色,CD45／SSC设门后可将骨髓细胞清晰地分出成熟细胞和幼稚细胞群,然后行FSC、SSC、McAb1-FITC、McAb2-PE、CD45-Cychrome五参数分析。结果：11例白血病患者骨髓形态学经FCM的免疫分型获得进一步确诊和分型。41例NHL骨髓侵犯标本免疫表型与其淋巴结病理免疫组化相符合的为80．5％(33／41),不相符的有19．5％(8／41),结合临床、病理、骨髓形态学诊断和骨髓FCM的结果,最终获得明确诊断。2例分别为巨大纵隔肿块和腹块的患者仅靠骨髓形态学和骨髓FCM确诊为T—NHL和B—NHL。结论：多参数FCM能进一步明确白血病和NHL骨髓侵犯的诊断,对急性淋巴细胞白血病和NHL的病例还可同时获得T或B细胞来源和细胞分化早期或后期的参数,有助于临床诊断、鉴别诊断和治疗方案的确定。     

间期荧光原位杂交技术在急性髓系白血病M2和M3型诊断中的应用

目的 探讨间期荧光原位杂交技术(FISH)在急性髓系白血病(AML)M2和M3诊断中的意义.方法 对初治的9例AML-M3、12例AML-M3及10例未能确定M2或M3的AML患者,应用FISH和反转录-聚合酶链反应(RT-PCR)检测AMLI/ETO和PML/RARα融合基因,协助诊断和指导治疗.结果 9例AML-M2中AMLI/ETO融合基因阳性率44.4%(4/9);12例AML-M3中PML/RARα融合基因阳性率83.3%(10/12),其中1例AML1/ETO融合基因阳性.确诊为AML-M2;10例AML中AML1/ETO融合基因阳性率30%(3/10),PML/RAR Ot融合基因阳性率50%(5/10),其余2例未检测到以上两种融合基因.结论 FISH是一种敏感、简便的分子遗传学新技术,具有高效、快速、灵敏等优点,对诊断AML的分型具有重要帮助,可进一步指导临床治疗.     

小儿急性白血病免疫表型和骨髓细胞DNA含量及其相互关系的分析

目的　了解小儿急性白血病（ＡＬ）的免疫表型、异倍体、细胞周期分布状况及其之间的关系。方法　应用流式细胞仪检测了４２ 例初诊为ＡＬ患儿的免疫表型及骨髓单个核细胞（ＭＮＣ）的ＤＮＡ含量。结果　４例ＡＬ患者同时表达了Ｂ系和髓系的抗原，预后差。ＡＬ患儿骨髓细胞周期的Ｓ期细胞百分率明显低于正常对照。而且，ＡＬＬ组中，亚二倍体患者的Ｓ期细胞百分率均值与超二倍体患者、二倍体患者比较存在显著差异性，ＡＮＬＬ组中，ＣＤ３３ ／ＣＤ１３ ＜ １ 患者的Ｓ期细胞百分率均值与ＣＤ３３ ／ＣＤ１３ ＞ １ 患者比较亦存在显著差异。结论　ＡＬ患儿的免疫表型、倍体关系、细胞周期及其之间的关系，与临床预后密切相关。     

Flow cytometric characterization of acute myeloid leukemia. Part II. Phenotypic heterogeneity at diagnosis.

The frequency and distribution of aberrant antigen expression are analyzed on bone marrow aspirates from 80 patients with newly diagnosed acute myeloid leukemia (AML) by multidimensional flow cytometry. Parameters examined are the light scatter profile of the leukemic cells and the correlative expression of different combinations of the CD2, 4, 5, 7, 11b, 11c, 13, 14, 15, 16, 33, 34, 38, and HLA-DR antigens. Antigen expression on leukemic cells in bone marrow is described by characteristic antigen expression patterns describing: (i) the percentage of cells expressing the antigen; (ii) the antigen density; and (iii) the distribution of the antigen on the leukemic cells. Typically the non-myeloid antigens are homogeneously expressed by the leukemic cells, whereas the myeloid associated antigen CD11b, CD11c, CD14, and CD15 are heterogeneously expressed. Comparison of the antigenic profiles of 80 bone marrow aspirates revealed an extreme interclonal heterogeneity. Comparison of the antigen expression patterns found in AML patients with the antigen expression in normal bone marrow revealed four patterns of aberrant antigen expression in AML: (i) expression of nonmyeloid antigens (i.e. CD2, CD5, and CD7 were present in 57, 60, and 37% of the patients, respectively); (ii) asynchronous expression of myeloid associated antigens (i.e. co-expression of CD34 and CD15 in 25% of the patients and expression of CD16 on immature myeloid cells in 15% of the cases); (iii) over-expression of myeloid associated antigens (e.g. CD34 in 16% of the cases and CD14 on neutrophilic cells in 19% of all patients); and (iv) absence of expression of myeloid associated antigens (e.g. lack of CD33 in 21% of the cases and lack of both CD11b and CD15 in 6% of all patients. Multidimensional flow cytometric analysis of bone marrow aspirates of AML patients disclosed that the leukemic cells of each AML patient had a unique antigenic profile and could be discriminated from their normal counterparts based on aberrant antigen expression and typical light scatter profiles. The ability to distinguish leukemic cells from normal cells allows the detection of residual leukemic cells during and after chemotherapy.     

成人急性髓细胞性白血病免疫表型与细胞遗传学及临床特征的关系

背景与目的:新的WHO分类已迅速应用于白血病的诊断。依据多个系相关抗原的表达,多参数高分辨流式细胞术可准确地识别白血病细胞的系列来源和分化阶段,而且某些抗原表达与细胞遗传学改变和预后密切相关。本研究旨在探讨初治成人急性髓细胞性白血病(acutemyeloidleukemia,AML)的免疫表型特征,并对其与FAB分类、细胞遗传学和临床表现的关系进行分析。方法:采用多参数高分辨流式细胞术对96例成人AML患者骨髓进行免疫表型分析,染色体G显带技术对其中的73例进行核型分析。结果:AML患者中,某些免疫表型特征与FAB分类具有相关性,包括M3中缺乏表达HLA鄄DR、CD34和CD56,但CD2的表达增加;M2中CD19、M5中CD14和CD56的表达增加,而M0中未见MPO的表达。本组AML核型异常率为54.8%,其中CD22、CD56和TdT的表达与核型异常有显著性相关。10例t(8;21)改变仅见于M2中,并高表达CD15、CD19、CD34和CD56,但未见CD2和CD7表达。7例伴t(15;17)的M3患者中未见淋系抗原的表达。此外,CD4和TdT抗原的表达与患者年龄、CD7和CD14的表达与外周血白细胞计数、CD4、CD14和CD56的表达与血小板计数等均有显著性正相关。结论:AML患者免疫表型与细胞遗传学的相关性提示AML抗原的异常表达可能与基因的异常改变密切相关。白血病免疫表型的检测有助于     

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.     

CD14+单核细胞系白血病细胞来源树突细胞体外刺激特异抗白血病T细胞应答

背景与目的:白血病细胞能在体外分化为树突细胞(dendriticcells,DCs),从而有希望用于白血病的免疫治疗。本研究旨在探讨CD14高表达的单核细胞系白血病(M4、M5)细胞分化而来的DCs体外诱导抗白血病T细胞应答的能力。方法:取5例初诊CD14高表达的M4或M5型白血病患者的骨髓标本,分离单个核细胞(bonemarrowmononuclearcells,BMMNCs),将白血病细胞分为3组:贴壁白血病细胞组、非贴壁白血病细胞组及总白血病细胞组。流式细胞术(flowcytometry,FCM)比较3组细胞的CD14表达。用含GM-CSF、IL-4和TNF-α或不含细胞因子的培养液培养细胞7～10天后,通过细胞形态学观察及FCM检测细胞表型,鉴定单核白血病细胞来源的DCs(monocyticleukemiacell-deriveddendriticcells,Mo-LDCs);采用异基因混合淋巴细胞反应(allogeneicmixedlymphocytereaction,Allo-MLR)以及细胞毒性T淋巴细胞(cytotoxicTlymphocytes,CTL)抗白血病细胞毒分析检测Mo-LDCs的免疫功能,染色体核型分析结合异常表面抗原确定Mo-LDCs的白血病来源。结果:3组中贴壁白血病细胞的CD14含量最高,在细胞因子联合诱导下,可分化为大量CD83 成熟DCs。在同一病例的3组细胞以及不同病例的总单核细胞组间,培养前CD14的表达率与诱导后CD83 DCs的产率成正相关(r=0.967,P=0.007)。Mo-LDCs具有典型的成熟DCs的形态及表型特征,在Allo-MLR中能刺激同种T细胞明显增殖,并能刺激扩增特异性抗白血病CTL。同时,Mo-LDCs持续存在所起源白血病的核型异常和异常表达的髓系抗原。结论:在细胞因子组合诱导下,M4、M5亚型AML的CD14 细胞可分化为具有免疫功能的Mo-LDCs,单核系白血病细胞的CD14表达高低可能预示其DCs分化能力。Mo-LDCs具有经典的DCs的表型及功能,还具有白血病的克隆异常,可用于M4、M5患者的免疫治疗。