伴髓系抗原表达的急性淋巴细胞白血病MIC分型特征分析

目的探讨伴髓系抗原（My）表达的急性淋巴细胞白血病（My^＋ALL）MIC分型特征。方法按常规骨髓涂片及过氧化物酶染色法对120例初治ALL患者进行形态学分型，采用流式细胞术检测白血病细胞免疫学类型，用R显带技术分析染色体核型，对My^＋ALL及My^-ALL患者MIC分型进行分析比较。结果120例初治ALL患者中My^＋ALL66例（55％），其中My^＋B-ALL50例，占B-ALL的56．8％：My^＋T．ALL14例，占T．ALL的50％；My^＋T、B-ALL2例，占T、B-ALL的50％。66例My^＋ALL患者形态学分型有10例（15．1％）误诊为急性非淋巴细胞白血病（ANLL）；54例My-ALL无一例误诊为ANLL。My^＋ALL患者形态学分型与免疫分型不符率或形态学分型不明确病例明显高于My-ALL（P〈0．01）。My^＋ALL患者95．5％表达CDl3，81．8％表达CD33，77．3％同时表达CDl3及CD33．1．5％表达CDll7。CDl4、CDl5及MPO表达阴性。My^＋ALL患者CD34阳性表达率明显高于My-ALL（P〈0．01）。My^＋ALL及My^-ALL患者异常染色体核型的检出率分别为72．3％和66．7％（P〉0．05），My^＋B-ALL患者的t（9；22）或t（9；22）伴其他染色体核型异常的检出率显著高于My^-B-ALL（P〈0．01）。My^＋T-ALL及My^-T-ALL患者未见t（9；22）异常。My^＋ALL和My^-ALL患者CR率分别为83．9％和79．0％，差异无统计学意义（P〉0、05）。结论My^＋ALLMIC分型部分细胞形态学可显示有髓系细胞特征，易被误诊为急性髓系白血病。My^＋ALL患者CD34表达率明显高于My^-ALL。My^＋B-ALL的t（9；22）异常显著高于My^-B．ALL。My^＋ALL与My^-ALL缓解率差异无统计学意义。

MIC categorization of acute lymphoblastic leukemia with myeloid surface antigen expression

OBJECTIVE: To explore the characteristics of morphology, immunophenotype and cytogenetics (MIC) of myeloid surface antigen-expressing acute lymphoblastic leukemia (My+ ALL). METHODS: One hundred and twenty untreated acute lymphoblastic leukemia (ALL) patients were diagnosed by standard bone marrow smear morphologic analysis and peroxydase staining. Flow cytometry and myeloid monoclonal antibodies (McAb) were used to analyze immunophenotype. Chromosome karyotypes were analyzed by R-band technique. RESULTS: Of 120 cases, 66 (55%) were My+ ALL, including 50 cases of My+ B-ALL (56.8% of B-ALL ), 14 cases of My T-ALL (50% of T-ALL) and 2 cases of My+ T and B-ALL (50% of T and BALL). Of 66 My+ ALL, 10 cases (15.1%) were misdiagnosed as acute non-lymphobastic leukemia (ANLL), the other 54 My- ALL cases were correctly diagnosed. The inconsistent rate between morphological and immunophenotype classifications was higher in My+ ALL than in My- ALL , and there were more atypical morphology cases in My+ ALL than in My- ALL (P < 0.01). In My+ ALL cases 95.5% expressed CD13, 81.8% CD33, 77.3% CD13 and CD33 simultaneouly, and 1.5% CD117, but none CD14, CD15 and MPO. CD34 expression rate in My+ ALL cases was significantly higher than that in My- ALL (P < 0.01 ). Cytogenetic abnormalities rates in My+ ALL and My- ALL were 72.3% and 66.7% (P > 0.05) respectively. t(9;22) and t(9;22) plus other cytogenetic abnormalities were detected more frequently in My+ LL cases than in My- B-ALL (P < 0. 01), and not in My+ T-ALL and My- T-ALL cases. The complete remission (CR) rates was 83.9% in My+ ALL and 79% in My- ALL(P > 0.05). CONCLUSION: My+ ALL had a specific characteristics in morphology, immunophenotype and cytogenetics. Some cases have a myeloid morphologic appearance and might be misdiagnosed as acute myeloid leukemia (AML). My+ ALL have a higher CD34 expression rate than My- ALL. t(9;22) abnormality was more frequently observed in My B-ALL than in My- B-ALL. There was no significant difference in CR rate between My+ ALL and My- ALL.