急性淋巴细胞白血病缓解期骨髓活检价值探讨

急性淋巴细胞白血病(ALL)经过化疗后,骨髓细胞学检查是最常用的方法,但无法了解骨髓中微小残留病灶的状况,用骨髓活检的方法,通过病理检查,可以比较全面了解急性淋巴细胞白血病经过化疗后骨髓中是否微小残留病灶。对临床的治疗与疗效判定有一定的意义,可作为判断远期预后的一个     

骨髓活检对小儿急性白血病疗效判定的临床意义

研究骨髓活检在小儿急性白血病治疗观察的临床应用。采用骨髓活检改良制片法对５０例急性白血病患锋诱导治疗２疗程后第六天施行骨髓涂片和活检,分别作定量观测,并进行对比分析。骨髓活检异常原始细胞计量与骨髓涂片原幼细胞百分率相关,但有不同。继续治疗观察,ＭＡＢＡ少量１３例全部缓解,中量组缓解２１／２３,多量组缓解１１／１４且有５例半年内复发,三且差别显著Ｐ〈０．０５）。提示骨髓活检ＭＡＢＡ检测,对小儿急性白     

骨髓活检对小儿急性白血病疗效判定的临床意义

研究骨髓活检在小儿急性白血病治疗观察的临床应用。采用骨髓活检改良制片法对 5 0例急性白血病患儿在诱导治疗 2疗程后第六天施行骨髓涂片和活检 ,分别作定量观测 ,并进行对比分析。骨髓活检异常原始细胞计量 (MABA)与骨髓涂片原幼细胞百分率 (MBP)相关 ,但有不同。继续治疗观察 ,MABA少量 1 3例全部缓解 ,中量组缓解 2 1 / 2 3,多量组缓解 1 1 / 1 4且有 5例半年内复发 ,三组差别显著 P<0 .0 5 )。提示骨髓活检 MABA检测 ,对小儿急性白血病疗效和预后评估意义显著 ,特别对于难治和复发的病例     

儿童免疫介导骨髓衰竭综合征研究进展

骨髓衰竭(bone marrow failure)是指由于各种病理因素使骨髓造血功能受抑制,导致外周血中一系或者全血细胞减少。骨髓衰竭综合征由一系列疾病组成,主要病因包括骨髓增生减低和(或)无效造血、造血原料不足、异常克隆细胞“占位”等。此类疾病可以是遗传性也可以是获得性,后者主要包括获得性再生障碍性贫血(AAA)、骨髓增生异常综合征(MDS)、阵发性睡眠性血红蛋白尿等(PNH)疾病。越来越多的研究表明70%以上获得性骨髓衰竭综合征的发病与免疫因素有关。本文主要对这类疾病作一介绍。一、AAAAAA是一种由多种原因引起的原发性或继发性骨髓造…     

三色流式细胞术在120例儿童急性白血病免疫分型中的应用

目的探讨三色流式细胞术在儿童急性白血病AL免疫分型中的应用价值，了解儿童AL抗原表达规律和免疫亚型的分布情况。方法采用CD45／侧散射（SSC）双参数散点图设门方法进行三色流式细胞术细胞表面及浆内分化抗原的分析。结果120例儿童白血病免疫分型可分为4类：未分化型占0．8％，急性髓细胞性白血病（AML）占35．0％，急性淋巴细胞白血病（ALL）占57．5％，混合型急性白血病占6．7％。69例儿童ALL中，B淋巴细胞白血病（B - ALL）占75．3％，T淋巴细胞白血病（T - ALL）占24．7％。AML伴淋巴系抗原表达为28．8％，主要表达CD5、CD7及CD19（均为9．6％）。B - ALL伴髓系抗原CD13、CD33表达分别为40．4％和5．8％，T - ALL伴髓系抗原CD13、CD33表达分别为35．3％和5．9％。结论应用流式细胞术几乎能对所有儿童急性白血病进行准确分型，对儿童白血病患者的治疗方案选择及预后判断等均有重要价值。     

儿童急性淋巴细胞白血病的研究进展

儿童急性淋巴细胞白血病（ＡＬＬ）的研究在最近数年已取得很大进展，免疫分开已明确分为五型，各型与临床有密切关系，细胞遗传学研究发现了多种染色体结构和数目异常。分子生物学技术证实一些染色体易位所累及的基因及其蛋白产物在疾病发生中起重要作用，治疗上强调分型治疗或针对特定危险度的治疗，具体治疗方法均由早期治疗。亚临床中枢神经系统治疗和连续治疗三部分组成。     

白血病骨髓基质细胞研究进展

骨髓基质细胞对造血细胞的增殖和分化有重要的调节作用,白血病病人不仅有造血细胞的恶性克隆性增殖,而且骨髓基质细胞的结构功能都有一定的改变,骨髓基质细胞通过分泌细胞因子和直接粘附对白血病细胞恶性克隆的选择、增殖,分化、迁移、凋亡有重要作用,这使我们从新的角度来认识白血病的发生和发展过程。     

儿童急性白血病细胞周期蛋白D1表达的研究

目的 　探讨细胞周期蛋白D1 (cyclinD1 )的表达与儿童急性白血病 (AL)的关系。方法 　采集 50例初发或复发的儿童AL患者 (AL组 )和 2 6例完全缓解AL(AL-CR组 )患者作为病例组 ,2 3例非肿瘤性疾病患者作为对照组。运用超敏SP免疫组织化学法 ,检测骨髓细胞中cyclinDl的表达情况。结果 　cyclinD1阳性率在AL、AL-CR和对照组中分别为 56 %、3 85%和 0 ,AL组明显高于AL -CR组和对照组 (P <0 0 1 ) ;AL组中的高危AL和标危AL阳性率分别为 86 36 %、32 1 4 % ,两者有显著差异 (P <0 0 1 )。结论　cyclinD1在儿童AL患者的表达率较高 ,它可能与AL的发病有关 ,而且可作为预后和疗效观察的指标。     

原血细胞对于儿童急性B淋巴细胞白血病预后判断的价值

目的 探讨儿童急性B 淋巴细胞白血病(B-ALL)巩固化疗期骨髓原血细胞(HGs)对于儿童急性B 淋巴细胞白血病(B-ALL)预后判断的意义.方法 回顾性分析196 例初发B-ALL 患儿,根据危险分型分为高危(n=55)、中危(n=69)和低危(n=72)3 组;根据临床结局分为完全缓解(n=165)和复发组(n=31).采用欧洲BIOMED-1 标准化流式细胞术微小残留病(MRD)检测方案,检测巩固化疗期HGs 数量.Kaplan-Meier 生存曲线统计患儿无事件生存率(EFS).结果 高危组患儿HGs 明显低于中危和低危组,差异均有统计学意义(PP1.0% 组,差异有统计学意义(P结论 HGs 可反映B-ALL 化疗效果,可用于B-ALL患儿疗效及预后的监测.     

儿童急性白血病发病机制的研究进展

急性白血病是儿童最常见的恶性肿瘤之一,其病因及发病机制仍未完全明确.目前已证明大部分急性白血病有克隆性染色体异常,TEL/AML1、BCR/ABL、PML/RAR-α等是常见的融合基因,通过对其检测可指导疾病诊疗和预后判断.近期的研究发现基因多态性也与白血病的易患性相关,如叶酸代谢相关基因、细胞色素P450和谷胱甘肽s-转移酶、苯醌氧化还原酶-1等.此外,酒精、烟草、肿瘤坏死因子α、干扰素均是致白血病发生的潜在危险因素,而干扰素调节因子-3和婴幼儿早期感染则也许能减少白血病的发生.     

以骨髓坏死为特征的幼儿急性淋巴细胞白血病1例

男,2岁。因发热10d,面色苍黄、骨骼疼痛2d 入院。患儿10d前无明显诱因出现不规则发热,体 温达38℃～39℃,伴乏力、食欲差。2d前体温升到 39.5℃,并出现面色苍黄、多处骨骼疼痛,血常规示: 血红蛋白86g/L,白细胞11.2×109/L,血小板64× 109/L,予抗感染治疗2d无效入院。查体:体温 39℃,急性热病容,中度贫血貌,面色苍黄,结膜、甲 床苍白,足背部、肩部可见少量针尖大小出血点,颌 下、颈部可触及2粒黄豆大小淋巴结,质软,活动度 可,无压痛,其余浅表淋巴结未触及。肝肋下 2.5cm,脾肋下2cm,质中、边缘钝。胸骨、四肢骨 骼及指骨、趾骨有明显压痛。…     

Isolated breast relapse after allogeneic bone marrow transplantation for childhood acute lymphoblastic leukemia

Unusual sites of relapses following bone marrow transplantation (BMT) for childhood acute lymphoblastic leukemia (ALL) are rarely reported. We report the case of a 16-year-old girl who presented with an isolated right breast relapse 8 months after allogeneic BMT for ALL in second remission. Biopsy showed an ALL infiltrate. Bone marrow and CSF were normal. The girl never showed before extramedullary involvement. She was treated with local radiotherapy and mild systemic chemotherapy. Nine months after breast relapse, she presented an isolated central nervous system relapse. The treatment of isolated extramedullary relapses following BMT is still controversial.     

Longitudinal gonadal function after bone marrow transplantation for acute lymphoblastic leukemia during childhood

Total body irradiation and high-dose chemotherapy, applied as a preparatory regimen for bone marrow transplantation (BMT) in children with acute lymphoblastic leukemia (ALL), are particularly hazardous to the gonads and, in addition, can impair hypothalamo pituitary-gonadal control. Longitudinal data on pubertal development and gonadal function in these patients are limited. Twenty-one ALL patients (15 males, 6 females) who had successfully undergone allogeneic BMT before puberty (age at BMT: 3.4-12.3 yr) were followed up in University Children's Hospital, Tübingen, Germany over 2 (minimum) to 14 (maximum) years. Tanner development scores, serum testosterone and estradiol, basal follicle-stimulating hormone (FSH) and luteinizing hormone (LH) were analyzed. During pubertal age, the levels of FSH and LH rose consecutively, resulting in noticeably elevated serum concentrations in 100% and 89%, respectively, of boys older than 14 years and in 75% and 75%, respectively, of girls older than 13 years. Nevertheless, pubertal development has been normal in all patients except in one boy and two girls who required substitution with sexual steroids, as timely puberty (i.e. boys < 14 years, girls < 13 years) did not start. In males with normal puberty, testosterone levels, however, were found to be low-normal. In conclusion, after BMT preceded by total body irradiation for childhood ALL, gonadal function is impaired. Even if normal pubertal development occurs, deficiencies in long-term endocrine function cannot be ruled out. In view of the high FSH levels, the prognosis for fertility is doubtful.     

儿童急性髓系白血病治疗进展

急性髓系白血病(AML)是由于造血干细胞分化障碍及增殖过度所致异常骨髓造血前体细胞聚集的恶性克隆性疾病。近年来随着危险度分层的合理应用、靶向药物的不断研发、支持治疗的进步、造血干细胞移植技术的日渐成熟,儿童AML的生存率已经较前有明显提高。文章综述儿童AML的治疗进展。     

miRNA在儿童急性淋巴细胞白血病中的研究进展

miRNA是一类小分子非编码RNA,根据其基因结构及功能不同分为不同家族,参与细胞的增殖、分化、凋亡等重要环节.不同家族在白血病等癌症中分别发挥着癌基因和抑癌基因的重要作用,这是近年来研究的新热点.儿童急性淋巴细胞白血病的诊断、耐药性、复发始终是学者面临的巨大难题,而许多miRNA与儿童白血病发病机制、诊断、预后、耐药性密切相关,该文对近年来与儿童急性淋巴细胞白血病相关的miRNA研究进展进行综述.     

Isolated breast relapse after allogeneic bone marrow transplantation for childhood acute lymphoblastic leukemia.

Unusual sites of relapses following bone marrow transplantation (BMT) for childhood acute lymphoblastic leukemia (ALL) are rarely reported. We report the case of a 16-year-old girl who presented with an isolated right breast relapse 8 months after allogeneic BMT for ALL in second remission. Biopsy showed an ALL infiltrate. Bone marrow and CSF were normal. The girl never showed before extramedullary involvement. She was treated with local radiotherapy and mild systemic chemotherapy. Nine months after breast relapse, she presented an isolated central nervous system relapse. The treatment of isolated extramedullary relapses following BMT is still controversial.     

Localized bone marrow relapse in acute lymphoblastic leukemia

Localized bone marrow relapse is rare in acute lymphoblastic leukemia. Discordant bone marrow specimens were found in an 11-year-old asymptomatic girl who had been in remission for six years and off chemotherapy for 2 1/2 years. One bone marrow sample showed marked leukemic infiltration, whereas marrow from another site was normal. Three months later, with normal peripheral blood counts, she developed severe back pain and x-ray evidence of vertebral collapse and periosteal changes in the public bone. At that time three of the four areas of bone marrow sampled showed leukemic involvement. Reinduction therapy was begun, and she is now in remission on maintenance chemotherapy. At this time, it is unclear whether routine performance of marrow aspirations and biopsies from multiple sites, in periodic follow-up examinations of patients with acute leukemia would allow earlier detection of relapse frequently enough to justify the procedure. The issue of localized bone marrow involvement, if more common than previously reported, should be addressed at the time a decision is being made to discontinue therapy.