AML骨髓“前ALIP”样结构数量及其与骨小梁距离对白血病复发的影响

本研究通过急性髓系白血病(AML)患者完全缓解(CR)期骨髓"前ALIP"样结构定位、定量异常的检测,探讨其与AML复发的相关性。对62例骨髓涂片示CR的患者骨髓活检塑料切片进行回顾性分析及预后随访,依据预后将其分为复发前组及未复发组。计算骨髓塑料切片每平方毫米内单个、两个聚集前体细胞数量及二者的总和,结合计算机图像分割法测量其与骨小梁间的精确距离,明确"前ALIP"样结构定位、定量异常与复发的相关性。结果表明:复发前组及未复发组骨髓"前ALIP"样结构数量分别为11±11.71和8.33±9.17个/mm2,均明显高于正常对照组(5.29±4.00)(P<0.01)。在"前ALIP"数量≥11个/mm2的17例患者中,复发前组12例,占70.6%,明显高于未复发组(29.4%,P<0.05);而复发前组"前ALIP"与骨小梁的相对距离为(341.31±266.16)μm,明显远于未复发组(242.41±174.65)μm(P<0.01),有向骨小梁间区迁移的趋势。在前"ALIP"与骨小梁之间平均距离≥341μm的18名患者中,复发前组14例,占77.8%,明显高于未复发组(P<0.01)。结论:AML患者CR期骨髓切片中"前ALIP"样结构平均数量超过11个/mm2或其与骨小梁间的平均距离超过341μm,预示AML可能早期复发,应及时进行再诱导缓解治疗。

Influence of pre-ALIP number and its distance from trabeculae on AML relapse

This study was purposed to detect the abnormal quantity and localization of pre-ALIP in bone marrow of acute myelocytic leukemia patients (AML) during the complete remission (CR) and investigate their correlation with AML relapse. The bone marrow biopsy and prognosis of 62 patients with CR were retrospectively analyzed. The bone marrow was divided into the pre-relapse group and the no-relapse group according to prognosis of patients. In order to clarify the correlation of abnormal quantity and localization of pre-ALIP with AML relapse, the number of single and double-cluster precursor cells and the sum of both were calculated, and their distance from bone trabeculae was surveyed with the computer image segment method. The results showed that the number of pre-ALIP in pre-relapse group (11 ± 11.71/mm(2)) and no-relapse group (8.33 ± 9.17/mm(2)) were more than that in normal control group (5.29 ± 4.00) (P < 0.01). The number of pre-ALIP more than 11/mm(2) was observed in 17 among all AML patients, and out of them 12 patients with pre-ALIP number >11/mm(2) (70.6) were found in the pre-relapse group, which was higher than that in no-relapse group (P < 0.05). While the distance between pre-ALIP and trabeculae (341.31 ± 266.16) μm] in pre-relapse group showed the tendency of migrating to the intermediate zone of bone trabeculae, compared with that in no-relapse group (242.41 ± 174.65) μm, P < 0.01]. Moreover, about 77.8 of 18 patients showed the distance of pre-ALIP from trabeculae was more than 341 μm in the pre-relapse group, and significantly higher than that in no-relapse group (P < 0.01). It is concluded that the average number of "pre-ALIP" more than 11/mm(2) or the average distance from trabeculae longer than 341 μm in bone marrow sections during CR may be the indicators for early relapse of AML.