慢性粒细胞白血病罕见染色体易位二例

慢性粒细胞白血病罕见染色体易位二例李湧，叶红，黄培山，韦叶育，杜锦妮，王慧芳，张九莲例１女，５０岁，壮族，农民，孕４产３。晚孕引产时查血象：ＷＢＣ为４１．６×１０９／Ｌ。患者１月余常有低热，肝脾不大，首次骨髓象诊断为反应性增生。第２次骨髓象：增生明显...     

慢性粒细胞白血病树突状细胞激活抗白血病免疫的实验研究

树突状细胞 (ＤＣｓ)是体内功能最强的抗原提呈细胞 (ＡＰＣ) ,在抗肿瘤免疫中发挥重要作用[1] 。Ｃｈｏｕｄｈｕｒｙ[2 ] 用荧光原位杂交 (ＦＩＳＨ)研究表明 ,在慢性粒细胞白血病 (ＣＭＬ) ,外周血获得的ＤＣｓ含ＢＣＲ/ＡＢＬ融合基因 ,在ｒｈＩＬ 2存在下能刺激自体外周血Ｔ细胞杀伤白血病细胞并抑制白血病细胞的生长。由于骨髓中含一定数量的Ｔ细胞 ,我们设想 ,在ＣＭＬ病人骨髓中加入自体ＤＣｓ可以活化这些Ｔ细胞 ,产生抗白血病免疫反应。1　材料与方法1 1　病人选择　为 3例经临床、血液学及细胞遗传学确诊的ＣＭＬ病人 ,其中女性 2…     

应用YAC探针进行荧光原位杂交检测慢性粒细胞白血病BCR基因重排

为检测慢性粒细胞白血病（ＣＭＬ）中ＢＣＲ基因重排，采用酵母人工染色体（ＹＡＣ）ＤＮＡ的Ｉｎ－ｔｅｒ－Ａｌｕ－ＰＣＲ产物为探针进行荧光原位杂交（ＦＩＳＨ）研究了１０例ＣＭＬ，其中包括初诊患者２例，ＣＭＬ急变并接受化疗２例，α干扰素治疗２例，自体骨髓移植术（ＡＢＭＴ）后３例和Ｐｈ染色体阴性ＣＭＬ１例。同时进行细胞遗传学和ＲＴ－ＰＣＲ检测。结果：９例ＣＭＬ的４６％～１００％的可分析核型显示ｔ（９；２２）易位，其中携带ｔ（９；２２）细胞最少者为１例自体骨髓移植术后８个月的患者，其６４％的分裂相存在ｔ（９；２２），３６％为正常核型；１例Ｐｈ（－）ＣＭＬ未见ＢＣＲ基因易位，而ＲＴ－ＰＣＲ（＋），提示ＡＢＬ基因片段插入２２ｑ１１，造成隐匿性Ｐｈ染色体。结果表明：应用ＹＡＣ探针进行原位杂交的定位明确。ＦＩＳＨ检测微小残留病（ＭＲＤ）比常规细胞遗传学方法更敏感，而且可以完成ＰＣＲ方法不易进行的定量分析。     

慢性粒细胞白血病细胞遗传学改变临床分析

目的探讨慢性粒性细胞白血病（CML）的细胞遗传学特点及意义。方法采用24h短期培养法制备骨髓染色体,应用G显带技术进行染色体核型分析。结果194例CML患者中,166例ph＋（占85．57％）,28例ph-（占14．43％）,其中158例具有典型易位,8例复杂变异易位,98例出现其他附加染色体异常,主要为：-22,＋8、-21、-11、-10、-14和-20等。结论CML患者进行细胞学研究对疾病的诊断、治疗和判断预后具有重要意义。     

荧光原位杂交检测慢性粒细胞白血病的染色体畸变

目的 检测费城染色体（Ｐｈｉｌａｄｅｌｐｈｉａ ｃｈｒｏｍｏｓｏｍｅ，Ｐｈ染色体）阴性，变异型Ｐｈ染色体及伴有其它染色体异常的慢性粒细胞白血病（ｃｈｒｏｎｉｃ ｍｙｅｌｏｉｄ ｌｅｕｋｅｍｉａ，ＣＭＬ）的ｂｃｒ／ａｂｌ融合基因。方法 双色荧光原位杂交技术，检测伴有８种不同的骨髓细胞染色体畸变ＣＭＬ患者的ｂｃｌ／ａｂｌ融合基因。结果 ３例变异型Ｐｈ和７例有标准型Ｐｈ的ＣＭＬ患者均为ｂｃｒ／ａｂｌ融合     

135例慢性粒细胞性白血病细胞遗传学分析

目的探讨慢性粒细胞性白血病(CML)的细胞遗传学特点及意义.方法采用24h短期培养法制备骨髓染色体.G显带技术进行染色体核型分析并照相.结果本研究135例患者中有108例Ph( )(占80%),27例ph(-)(占20%);108例Ph( )病例中,具有典型易位即t(9;22)(q34.1;q11.21)100例,变异易位和涉及其他染色体异常的有8例.47,XX, 8,t(9;22)/46,XY 1例;49,XY 8、 9、 20,双Ph( )1例;46,XX,t(9;22)-17 i(17q)1例(慢粒急变).2例单纯变异Ph易位t(17;22)和t(21;22),3例复杂变异易位为46,XX,t(5;9;22)和46,XX,t(7;9;22),46,XX,t(9;12;22).结论白血病进行细胞遗传学研究对疾病的诊断和预后判断具有重要的价值.     

应用YAC探针进行荧光原位杂交检测慢性粒细胞白血病BCR…

为检测慢性粒细胞白血病中ＢＣＲ基因重排，采用酵母人工染色体ＤＮＡ的Ｉｎｔｅｒ－Ａｌｕ－ＰＣＲ产物为探针进行荧光原位杂交研究了１０例ＣＭＬ，其中包括初诊患者２例，ＣＭＬ急变并接受化疗２例，α干扰素治疗２例，自体骨髓移植术后３例和Ｐｈ染色体阴性ＣＭＬ１例，同时进行了细胞遗传学和ＲＴ－ＰＣＲ检测。     

应用荧光原位杂交技术检测慢性粒细胞白血病的融合基因

目的 应用荧光原位杂交技术(FISH)直接检测慢性粒细胞白血病(CML)的融合基因(BCR/ABL)以辅助临床诊断和治疗白血病.方法 应用FISH技术检测25例CML自1991年-2008年制备染色体剩余细胞悬液的BCR/ABL,6例是2008年的标本,7例是1991年-1995年的标本,余10例标本是2001年-20...     

180例慢性粒细胞白血病骨髓染色体畸变及意义

目的　研究骨髓染色体畸变与慢性粒细胞白血病 (慢粒 )不同病期的相关性及其临床意义。方法　采取新鲜骨髓 ,进行短期培养 (48小时或 12小时预加秋水仙素培养 )制备染色体标本 ,分析 180例慢粒患者慢性期、加速期、急变期骨髓染色体的变异情况。结果　 180例慢粒患者 ,其中 16 4例Ph染色体阳性 (Ph ) ,占 91 1% ;16例Ph染色体阴性(Ph - ) ,占 8 9%。慢性期 133例Ph ,占总数的 73 9% ;加速期 9例Ph ,占总数 5 0 % ;急变期 2 2例Ph ,占总数12 2 %。 16 4例Ph 慢粒患者中 2 5例 (15 2 % )伴有额外染色体异常 ,其中慢性期占 4 2 7%、加速期占 2 4 %、急变期占8 5 3%。结果表明随着病情的进展 ,Ph 阳性率明显增高 ,其它染色体异常率也明显增高。结论　骨髓染色体畸变与慢粒白血病的病程进展、疾病预后有着十分重要的相关性 ,随着病情的演变 ,骨髓染色体畸变趋于复杂化。进行染色体分析对临床诊断及治疗慢粒具有十分重要的指导意义。     

慢性粒细胞白血病患者染色体检查及预后意义探讨

目的探讨慢性粒细胞白血病(CML)患者染色体变化的有关特点及预后意义.方法染色体制备采用骨髓细胞短期培养法,应用G、R显带技术对85例CML患者的骨髓细胞进行遗传学分析.结果 85例CML患者中,78例检出典型Ph染色体,占91.76%,3例为变异Ph易位,占3.53%,4例Ph染色体阴性,占4.71%,10例核型呈嵌合状态,13例出现附加染色体异常,主要为 8,i(7), Ph, 22, 12等,其中9例为加速和急变期患者,占64.29%.结论 CML是一种高度异质性疾病,非随机的附加染色体异常与患者临床分期高度相关.CML患者进行染色体分析对于疾病的诊断及鉴别、指导临床治疗、判断预后具有重要意义.     

De novo hairy cell leukemia with a major BCR/ABL1 rearrangement: A case report with a literature review

Hairy cell leukemia (HCL) is a very rare mature B‐cell neoplasm and its simultaneous occurrence with chronic myeloid leukemia has been reported in only three cases. The pathogenesis and relationship of the two diseases are not clear. Here we report a case of HCL expressing a BCR/ABL1 clone, which showed molecular remission of the fusion clones and achieved partial remission over nine months of cladribine therapy. After a thorough analysis of previous studies and the results of this patient, we speculate that a subclone evolved to have an additional genetic BCR/ABL1 rearrangement. We also review all published literature on HCL with BCR/ABL1 rearrangement and discuss the pathophysiology of these unusual cases.     

Crosstalk between BCR/ABL and RNAi

Chronic myeloid leukemia (CML) is a malignant disease of progenitor myeloid cells caused by chromosomal translocation that results in the forming of diminutive Philadephia chromosome that harbors BCR/ABL fusion oncogene. The product of this oncogene, a tyrosine kinase, alters several important regulatory pathways related to cell growth and differentiation thus leading to cancer transformation. Major form of CML therapy is based on tyrosine kinase inhibitors, first of all imatinib (IM). Some patients develop resistance to IM in the course of treatment. In the process of leukemogenesis the activity of miRNAs – one of groups of RNAs involved in RNA interference (RNAi) – is altered. Signatures of altered miRNAs activity may serve as a prognostic factor in the development and therapy of several diseases. Moreover, other group of RNAs involved in RNAi – siRNA – might be valuable addition to array of specific therapeutics targeted the BCR/ABL kinase.     

荧光原位杂交技术检测BCR/ABL融合基因的研究

目的建立荧光原位杂交技术平台,应用FISH技术检测在CML检测BCR/ABL融合基因,探讨FISH技术在在CML中应用的价值。方法应用FISH对BCR/ABL探针进行前期的验证,建立正常阈值,再应用该探针检测CML中BCR/ABL融合基因,进行临床检测评估。结果主要假阳性信号模式的正常阈值为1G1R1F 11%、1G1R2F 2%。75例样本FISH检测出48例阳性,15例经细胞遗传学检测,12例检测结果与FISH结果一致,3例CG为阴性,FISH检测为阳性。结论荧光原位杂交技术应用于临床检测之前应进行探针的前期验证,制定一套规范实验流程,且FISH技术在CML诊断、分型、临床治疗方案的制定、预后的判断以及微小残留病变检测上均有重要的价值。     

二氢青蒿素对K562细胞BCR/ABL融合基因表达的影响及意义

目的 探讨二氢青蒿素( dihydroartemisinin,DHA)对白血病细胞K562 BCR/ABL融合基因表达的影响及意义.方法 采用噻唑蓝比色方法检测不同浓度的DHA对于K562细胞的增殖抑制作用,并计算不同培养时间点的抑制率.用逆转录PCR检测K562细胞处理前后BCR/ABL融合基因的表达变化,流式细胞仪检测K562细胞的凋亡情况.结果 DHA(10～160 μmol/L)能抑制K562细胞的增殖,随着浓度增加抑制作用明显增强,培养24 h后抑制率从52.76％增加到94.65％;用浓度为20μmol/L的DHA对K562细胞作用12～48 h后,逆转录PCR检测BCR/ABL融合基因表达,△Ct值为4.45±0.25和5.23±0.21.与对照组(4.23±0.21)相比,差异有统计学意义(P＜0.05).结论 DHA可通过影响BCR/ABL融合基因的表达抑制K562细胞的增殖.这可能是导致K562细胞凋亡的原因之一.     

BCR/ABL重组质粒实时荧光定量PCR标准品的制备

目的：用T-A克隆法构建含BCR/ABL融合基因的重组质粒,并用实时定量PCR（RQ-PCR）方法制备标准品。方法：通过培养细胞,提取总RNA并逆转录为cDNA后做PCR,电泳胶回收纯化,T-A克隆与pUCm-T载体连接,转染DH5a菌,蓝白斑筛选阳性菌落后,大量提取质粒,再进行RQ-PCR,最后制得BCR/ABL的重组质粒标准品。结果：蓝白斑筛选实验、PCR扩增均证实BCR/ABL融合基因重组到pUCm-T载体上,经RQ-PCR定量后得到BCR/ABL重组质粒标准品的标准曲线。结论：该方法能大量制备质粒标准品,并且可被推广应用。     

BCR/ABL融合基因与慢性粒细胞白血病的发生

BCR/ABL融合基因是一个重要的凋亡抑制基因,具有较强的PTK活性。 src激酶﹑蛋白激酶家族C﹑信号转导和转录激活因子（STAT）等在BCR/ABL融合基因介导的肿瘤恶性转化中起着重要的作用。     

双色双融合与额外信号探针在BCR/ABL融合基因检测中的比较及其意义

目的 探讨DCCF(dual color dual fusion)探针与ES(extra signal)探针在BCR/ABL融合基因检测中信号表现的特点,并明确其信号特征与染色体核型的相互关系.方法 对初治65例慢性粒细胞白血病(chronic myelocytic leukemia,CML)及50例急性淋巴细胞白血病(acute lymphoblastic leukemia,ALL)患者骨髓标本进行BCR/ABL的DCDF探针的荧光原位杂交(fluorescence in situ hybridization,FISH)检测,FISH阳性标本则使用ES探针再次进行荧光原位杂交进行BCR断裂点的检测,同时对其中47例CML和40例ALL进行了核型分析.结果 FISH结果示65例CML均为BCR/ABL阳性,DCDFFISH中有17例为非典型信号表现,ES-FISH有12例为非典型信号表现;50例ALL中7例BCR/ABL阳性,ES探针显示5例BCR断裂点位于m-bcr,2例位于M-bcr.核型分析CML检出Ph阳性98%(43/44),ALL检出Ph阳性22%(7/32).结论 DCDF-FISH、ES-FISH以及核型分析各有其特性.根据每种方法的特性,对实验结果进行综合分析可对遗传学特征作出更准确判断.

Abstract：

Objective To investigate the signal patterns of dual color dual fusion (DCDF) probe and extra signal (ES) probe in the detection of BCR/ABL fusion gene, and illustrate the relation between the fluorescence in situ hybridization (FISH) pattern and the karyotype. Methods Sixty-five cases of chronic myelocytic leukemia(CML) and 50 cases of acute lymphoblastic leukemia (ALL) were detected by FISH with DCDF probe, the BCR/ABL positive samples were detected by FISH with ES probe. Among these cases, 47 cases of CML and 40 cases of ALL perform conventional cytogenetics simultaneously. Results All 65 cases of CML were all BCR/ABL positive by FISH. 17 cases showed the atypical pattern by DCDFFISH, and 12 cases showed the atypical pattern by ES-FISH. There were 7 cases of BCR/ABL positive in 50 cases of ALL by FISH. By ES-FISH, there were 5 cases in which the break-point of BCR gene was located in m-bcr, 2 cases in which the break-point of BCR gene was located in M-bcr. Conventional cytogenetics demonstrated that 43/44(98 %) cases of CML and 7/32(22 %) cases of ALL were Ph positive.Conclusion The features of DCDF-FISH, ES-FISH and conventional eytogenetic are different from each other. According to the features of these method, it can increase the precision of the adjustment of genetic feature to analyze these results comprehensively.     

Complex/variant translocations in chronic myelogenous leukemia (CML): genesis and prognosis with 4 new cases

In 5–10% of cases with CML, variant or complex translocations (CT) are seen that may result in atypical fluorescence in situ hybridization signal patterns. Dual color, dual fusion fluorescence in situ hybridization (D-FISH) patterns are instrumental in identifying the genesis of these CT, but their prognostic implications remain controversial. The most common mechanism is a two-step process in which a standard two-way translocation (9;22) is followed by subsequent rearrangements involving other chromosomes. The second common mechanism is the one-step process wherein breakage occurs simultaneously on different chromosomes leading to CT. The typical D-FISH pattern seen with the one-step mechanism is 1F2G2R, while the pattern for the two-step mechanism can be variable (2F1G1R, 1F1G1R, 1F1G2R, 1F2G1R, etc.). We have studied 4 cases of CT using metaphase FISH with triple color, dual fusion ASS1, ABL1 and BCR probes to understand the genesis of these CT. All the patients were treated with imatinib, but only patients 3 and 4 showed remission. Our results indicate that the CT in cases 1, 3 and 4 arose from a one-step mechanism and case 2 from a multi-step mechanism. Response to imatinib varied from full remission to no response. Long term follow-up is necessary to evaluate the prognostic implications of these CT.