急性红白血病的生物学特征与临床疗效研究

本研究探讨急性红白血病(AML-M6)的生物学特征与临床疗效的关系。对29例M6初治患者细胞形态学、免疫表型和染色体核型进行回顾性分析并观察临床化疗效果,同时随机抽取30例AML-M2(急性粒细胞白血病部分分化型)作为对照。结果表明:M6患者的外周血中均可见幼稚细胞(2%-10%)及有核红细胞,骨髓穿刺细胞学检查显示19例伴有多系细胞发育异常,累及二系细胞或三系细胞。流式细胞术检测表明,M6Gly-A(血型糖蛋白A)的表达率高达(66.67±23.86)%,明显高于其在M1,M2,M3,M4和M5中的阳性表达率(P<0.01)。M6高表达HLA-DR(60.00±24.79)%],CD34(40.00±24.79)%],CD38(33.33±23.86)%],髓系抗原主要表达CD13(66.67±23.86)%],MPO(33.33±23.86)%],CD33(46.67±25.25)%],CD15(33.33±23.86)%],CD117(46.67±25.25)%]。部分病例伴有淋系抗原的表达,如CD3、CD4、CD19,其中CD4的表达高达26.67%。M6中CD38、CD33、CD15、MPO的阳性表达率低于M2患者。9例M6患者染色体的检查显示,4例存在核型异常,异常率达44.44%,其中复杂核型异常1例。M6患者化疗完全缓解率为29.41%,低于M2患者化疗完全缓解率(68.18%,P<0.01)。结论:Gly-A是鉴别M6与其他亚型急性髓性白血病的一个重要标志,M6有自己独特的生物学表型,其化疗效果不佳可能与其生物学特征有关。

Biological Characteristics and Therapeutic Effect of Acute Erytho-Leukemia

The objective of this study was to investigate the biological characteristics and the therapeutic effect in patients with acute erythroleukemia (AML-M(6)). Morphology, immunophenotype and cytogenetics were retrospectively analyzed in 29 patients with AML-M(6) and were compared with 30 AML-M(2) patients. The results showed that there were immature cells (2% - 10%) and erythroblast, and puncture of bone marrow revealed myelodysplastic features involving multiple hemopoietic lineages in bone marrow of 19 patients. Flow cytometry indicated that the expression frequency of Gly-A in M(6) significantly increased (66.67 +/- 23.86)% and higher than that in M(1), M(2), M(3), M(4) and M(5) (P < 0.01). The expression frequencies of HLA-DR (60.00 +/- 24.79%), CD34 (40.00 +/- 24.79%), CD38 (33.33 +/- 23.86%) in M(6) were high, and the frequencies of myeloid immunophenotypes CD13 (66.67 +/- 23.86%), MPO (33.33 +/- 23.86%), CD33 (46.67 +/- 25.25%), CD15 (33.33 +/- 23.86%), CD117 (46.67 +/- 25.25%) were common as well in M(6). Lymphocytic immunophenotypes CD3, CD4, CD19 were detected in part of patients with M(6), and the expression frequencies of CD4 was 26.67%. The expression frequences of CD38, CD33, CD15, MPO in M(6) were less common than that in M(2) (P < 0.01). In 4 out of 9 M(6) patients the chromosomal abnormatility (44.44%) was seen, in one of which complex chromosome abnormality was found. The complete remmision rate of M(6) patients was 29.41%, and lower than that of M(2) patients (68.18%, P < 0.01). It is concluded that Gly-A is a specific immunophenotype in M(6), which can help to distinguish M(6) from other types of acute myeloid leukemia. Poor clinical therapeutic response may correlated with its biological characteristics.