急性混合细胞白血病诊断及疗效的临床研究

目的 探索急性混合细胞白血病(acute mixed lineage leukemia, AMLL)的临床和实验室特征以及疗效和预后.方法 根据骨髓细胞形态学、化学染色和免疫表型结果诊断AMLL,评价疗效及影响疗效的有关因素.结果 AMLL可有发热、贫血、淋巴结肿大、肝脾肿大等临床表现.半数患者属高白细胞白血病.所有患者骨髓增生明显活跃,原始 幼稚细胞占0.86(0.79～0.96).8例患者免疫表型均为B-Ly/My .兼顾粒、淋二系的方案诱导化疗的7例AMLL中,6例首次完全缓解(CR1),1例发生诱导化疗有关死亡,完全缓解后坚持巩固强化治疗的3例患者,已平均无病生存7(5～9)个月.结论 AMLL属特殊类型的白血病,其诊断有赖于对细胞形态学、化学染色和免疫分型的综合判断.对AMLL的治疗应予兼顾粒、淋二系的诱导和巩固化疗方案,缓解率较高,但长期疗效的评价还有待进一步观察.

Diagnosis and therapeutic outcome of acute mixed lineage leukemia

Objective To investigate the clinical and laboratorial features of acute mixed lineage leukemia (AMLL),as well as its chemotherapeutic and effect prognosis. Methods AMLL was diagnosed according to the findings of morphology,cytochemistry and the immunophenotype of bone marrow cells. Therapeutic outcome was evaluated and the relative factors were analyzed. Results Clinical presentations of 8 AMLL patients included fever,enlargement of the lymph nodes,spleen and/or liver. Half patients belonged to hyper-leukocytic leukemia. The marrows of all the patients were markedly hypercellular with leukemic cells accounting for 0.86(0.79-0.96). The immunophenotypes of 8 patients were all B-Ly/My phenotype. Seven of the 8 patients received the induction chemotherapy with the regimen targeting both myeloid and lymphoid lineage,in whom 6 patients were completely remitted,and 1 patient died of induction chemotherapy-related death. Three of the 6 patients were continually given chemotherapy and the duration of disease-free survival has reached to 7 months (ranging from 5 to 9 months). Conclusion AMLL,a specific leukemia,should be diagnozed on the overall analysis of cell morphology,cytochemistry and immunophenotype. Modality of chemotherapy for AMLL should aim at both acute lymphoid leukemia and acute nonlymphocytic leukemia. Further study is needed to elucidate the long-term prognosis of AMLL.