急性白血病Ly+AML型和My+ALL型预后因素的临床研究

为了研究Ly+AML(表达淋巴系抗原的急性髓性白血病),My+ALL(表达髓系抗原的急性淋巴细胞白血病),AML(急性髓性白血病),ALL(急性淋巴细胞白血病)和BAL(急性双表型白血病)的预后,采用CD45/SSC双参数散点图设门,应用三色流式细胞术,对197例AL(急性白血病)初诊患者骨髓标本进行免疫分型,采用EGIL(白血病免疫分型欧洲协作组)积分系统,将患者分为5组ALL 43例,AML 53例,Ly+AML 39例,My+ALL 53例,BAL 9例.结果表明Ly+AML(淋系抗原以CD7表达最常见,占53.8%)与My+ALL(髓系抗原以CD13表达最常见,占47.2%)相比,在白细胞数＞100×109/L的例数、CD34阳性率及完全缓解(CR)率方面,差别无统计学意义(P＞0.05),但在肝、脾、淋巴结肿大的例数方面,差别有统计学意义(P＜0.05),My+ALL的例数相对更多.ALL与My+ALL在白细胞数＞100×109/L的例数、肝脾淋巴结肿大的例数、CD34阳性率及CR率方面,差别均无统计学意义(P＞0.05).AML与Ly+AML相比,在白细胞数＞100×109/L的例数、肝脾淋巴结肿大的例数及CD34阳性率方面,差别无统计学意义(P＞0.05),但在CR率方面,差别有统计学意义(P＜0.05),AML患者的CR率相对更高.BAL与Ly+AML和My+ALL相比,虽然BAL患者的CR率(仅37.5%)明显低于前两者(分别低了16.8%和27.8%),但是由于BAL的例数太少,差别并无统计学意义(P＞0.05).结论Ly+AML的临床化疗可能应兼顾AML+ALL的两方面,因为它的预后因淋系抗原的表达而更差;而对于My+ALL来说,它的预后并没有因髓系抗原的表达而与ALL表现出明显差异,因此可以考虑采用与ALL相同的化疗方案.

Clinical Study on Prognosis of Acute Leukemia Subtypes Ly + AML and My + ALL

The purpose of this study was to investigate the prognosis of acute myelogenous leukemia (AML), acute lymphoblastic leukemia (ALL), lymphoid antigen-positive acute myeloid leukemia (Ly + AML), myeloid antigen-positive acute leukemia (My + ALL) and biphenotypic acute leukemia (BAL). Immunophenotyping was performed on medullary specimens of 197 acute leukemia (AL) patients by using three-color flow cytometry analysis and CD45/SSC gating. The scoring systems proposed by EGIL was adopted to classify the AL patients into five groups: 43 of ALL, 53 of AML, 53 of My + ALL, 39 of Ly + AML and 9 of BAL patients. The results showed that in Ly + AML, CD7 was the most common (53.8%) as compared to other lymphoid markers, however, in My + ALL CD13 was the most common (47.2%) as compared to other myeloid markers. Compared with Ly + AML, My + ALL had higher incidences of enlargement of liver, spleen and lymphnodes significantly (P<0.05). As for the case numbers of WBC counts > 100 x 10(9)/L, the positive rate of CD34 and the complete remission rate there was no obvious difference between groups of Ly + AML and My + ALL (P>0.05). As for incidences of enlargement of liver, spleen and lymphnodes, the case numbers of WBC counts > 100 x 10(9)/L, the positive rate of CD34 and complete remission rate, no obvious difference was found between ALL and My + ALL (P>0.05). Compared with AML, Ly + AML had lower complete remission rate significantly (P<0.05). As for incidences of enlargement of liver, spleen and lymphnodes, the case numbers of WBC counts > 100 x 10(9)/L and the positive rate of CD34, no obvious difference was found between AML and Ly + AML (P>0.05). Compared with Ly + AML and My + ALL, BAL showed no significant difference in complete remission rate (P>0.05) because the number of BAL patients was too small. It is concluded that since Ly + AML has lymphoid markers, and the prognosis of Ly + AML is worse than AML, the clinical therapy for Ly + AML should contain both AML and ALL. Though My + ALL had myeloid markers, no significant difference was found between My + ALL and ALL, it might be supposed that their therapy could be the same.