急性髓系白血病M1的免疫学特征和预后分析

本研究探讨急性髓系细胞白血病M1（AMLM1）免疫学特征及其预后,同时探讨其与AMLM2以及急性淋巴细胞白血病（ALL）免疫学鉴别的要点。采用CD45/SSC双参数散点图设门,应用三色流式细胞术对47例M1的初诊患者骨髓标本进行免疫分型,并对其中17例进行核型分析;另外,选择同期51例M2的初诊患者及58例ALL初诊患者作为对照。结果表明：M1患者的CD33阳性率达到100%,且灵敏度高,但特异性低;M1患者的CD11b、CD15、MPO、CD117的阳性率均显著低于M2患者（p〈0.05）;Ly＋AML的M1患者的T系抗原阳性率高于Ly＋AMLM2患者（p〈0.05）;与ALLPro-B相比,AMLM1患者高表达HLA-DR,髓系抗原CD13、CD15、CD33、CD117、MPO,T系抗原CD4、CD7均显著高表达（p〈0.05）;与ALLPre-B相比,M1患者高表达HLA-DR、CD34;髓系抗原CD13、CD15、CD33、CD117、MPO,T系抗原CD4、CD5均显著高表达（p〈0.05）;与T-ALL相比,M1患者早期抗原HLA-DR、CD34,髓系抗原CD13、CD15、CD33、CD117、MPO均显著高表达（p〈0.05）;M1患者中CD7＋患者CR率和CD7-患者CR率之间没有统计学差异（p〉0.05）,CD34＋患者CR率和CD34-患者CR率之间没有统计学差异（p〉0.05）,M1患者CR率低于M2患者（p〈0.05）,其达到CR的时间长,高白细胞白血病的发生率高（p〈0.05）,高白细胞白血病的CR率低（p〈0.05）。结论：M1患者的髓系抗原CD33、CD13均高表达,早期抗原HLA-DR也高表达,但髓系抗原CD11b、CD15、MPO、CD117表达不高,T系抗原CD4、CD7高表达;M1和M2免疫学方面没有明确的、特征性的标志可用来鉴别,但M1患者的CD11b、CD15、MPO、CD117的阳性率均显著低于M2患者,在鉴别M1与M2时可作为参考指标之一;形态学上不易分辨的AMLM1和ALLPro-B,ALLPre-B,T-ALL可以通过免疫学特征的分析得到鉴别;CD117主要表达于AML,对于AML和ALL的鉴别诊断有意义;M1患者的预后比M2患者差。

Immunologic Characteristics and Prognosis of Acute Myeloid Leukemia M1

The study was aimed to investigate the immunological characteristics and prognosis of acute myeloid leukemia (AML) M1 and to find the main points in immunology to differentiate AML M1 from M2, and M1 from ALL(proB, preB, T). Immunophenotyping was performed in 41 AML M1 patients by three-color flow cytometry analysis using CD45/SSC gating, meanwhile the cytogenetic analysis was performed in 17 patients. 51 newly diagnosed AML M2 patients and 58 newly diagnosed ALL patients were used as control at the same time. The results showed that the positive rate of CD33 in M1 was 100%, which was high in sensitivity, but low in specificity; the positive rate of CD11b, CD15, MPO, CD117 in M1 were significantly lower than that in M2 (p<0.05); the positive rate of T-lineage antigen in Ly+AML M1 was higher than that in M2 (p<0.05); compared with ALL ProB, M1 had high expression of HLA-DR, simultaneously myeloid antigen CD13, CD15, CD33, CD117, MPO and T-lineage antigen CD4, CD7 were all highly expressed (p<0.05); compared with ALL PreB, M1 had high expression of HLA-DR, CD34, meanwhile myeloid antigen CD13, CD15, CD33, CD117, MPO and T-lineage antigen CD4, CD5 were all highly expressed (p<0.05); as compared with T-ALL, the early-phase antigen HLA-DR, CD34, myeloid antigen CD13, CD15, CD33, CD117, MPO of M1 were all significantly highly expressed (p<0.05). In M1, the complete remission(CR) rate in patients with CD7 positive had no statistical difference from that in patients with CD7 negative (p>0.05); the CR rate of patients with CD34 positive had no statistical difference from that of patients with CD34 negative (p>0.05); CR rate in M1 was lower than that in M2 (p<0.05), time to reach CR was longer, the incidence of hyperleukocytic acute leukemia was higher (p<0.05), CR rate in hyperleukocytic acute leukemia was lower (p<0.05). It is concluded that the myeloid antigen CD33, CD13 in M1 are highly expressed, early-phase antigen HLA-DR in M1 is also highly expressed, but the myeloid antigen CD11b, CD15, MPO, CD117 in M1 are lowly expressed, T-lineage antigen CD4,CD7 in M1 are highly expressed in the meantime. There is no definite characteristic marker in immunology to differentiate M1 from M2, but as the positive rate of CD11b, CD15, MPO, CD117 in M1 are significantly lower than that of M2, CD11b, CD15, MPO, CD117 can be used as reference indicators to differentiate M1 from M2. AML M1, ALL ProB, ALL PreB and T-ALL, which are difficult to differentiate in morphology can be well seperated through the analysis of immunological phenotype. CD117 is mainly expressed in AML, which is useful for the differentiation diagnosis between AML and ALL. The prognosis of M1 is worse than that of M2.