髓系抗原表达在成人急性淋巴细胞白血病中的临床意义

【目的】 探讨成人急性淋巴细胞白血病(ALL)患者髓系抗原表达与临床特征及疗效的相关性,比较不同诱导方案治疗MyAg+ALL的疗效?【方法】 回顾性分析2006年1月至2011年5月我院收治的159例初治ALL患者资料,中位年龄26 (14 ~ 76) 岁?根据流式细胞术免疫分型分为髓系抗原阳性表达MyAg+ALL 73例和阴性表达MyAg- ALL 86例?分析髓系抗原表达与临床特征?近期疗效及5年总生存率的关系?【结果】 159例ALL患者中,髓系抗原表达占45.9%,以CD13?CD33为主,分别为34.2%和21.4%;CD34在MyAg+ALL中表达阳性率高于MyAg-ALL组(75.3% vs 60.5%,P = 0.046);T-ALL髓系抗原表达阳性率高于B-ALL(66.7% vs 42.8%,P = 0.04);MyAg+ALL患者形态学分型与免疫学分型不相符率(12.3%)明显高于MyAg-ALL(0%)?VDLP?VDCP?MA不同诱导方案治疗MyAg+ALL的完全缓解率(CR)分别为84.2%?75%及62.5%,三组间CR率无显著差别?MyAg+ALL组CR率低于MyAg-ALL组 (74.5% vs 88%,P = 0.047),但两组5年总体生存率差异无统计学意义(32.8% vs 25.8%,P = 0.803)?【结论】 成人ALL髓系抗原表达与大多数临床特征及疗效无明显相关性?采用米托蒽醌联合阿糖胞苷(MA)诱导方案治疗MyAg+ALL的CR率并不高于VDLP?VDCP方案?

Significance of Myeloid Antigen Expression in Adult Acute Lymphoblastic Leukemia

【Objective】 The objective of this study was to investigate the myeloid antigen expression features of adult acute lymphoblastic leukemia (ALL) patients and its correlation with clinical characteristics and prognostic significance, then compare the effects of various induction regimen for MyAg+ALL patients.【Methods】 A total of 159 newly diagnosed ALL patients with a median age of 26 years were enrolled in this study from January 2006 to May 2011. These patients were divided into myeloid antigen-positive group (MyAg+ALL) and myeloid antigen-negative group (MyAg-ALL) based on the flow cytometric (FCM) analysis in bone marrow. Myeloid antigen expression and its correlation with the clinical features, short-term efficacy and 5-year overall survival were assessed in the two groups.【Results】 Myeloid antigen expression was detected in 45.9% out of 159 cases and CD13, CD33 were the most commonly expressed MyAg (31.4% and 21.4%, respectively). The clinical and biological characteristics of ALL patients showed that higher percentage of incoincidence of classification between morphology and immunology and higher CD34 positivity were found to be correlated with MyAg+ALL. Significant difference was observed in the expression of MyAg between the groups of patients with T-ALL (66.7%) and B-ALL (42.8%). The complete remission (CR) rate was not significant in MyAg+ALL patients after receiving VDLP, VDCP or MA as induction therapy. MyAg expression was associated with lower CR rate but not with 5-year overall survival rate.【Conclusion】 Induction treatment combining mitoxantrone and cytarabine would not improve the CR rate of MyAg+ALL. MyAg expression was not correlated with prognosis in adult ALL.