骨髓形态学评价在进展期慢性髓细胞白血病格列卫治疗初期的意义

目的 分析进展期慢性髓细胞白血病(CML)格列卫治疗初期骨髓细胞形态学的变化,探讨其在评价病情变化及指导治疗中的意义.方法 Ph染色体阳性CML进展期患者16例,其中加速期9例、急变期7例,口服格列卫0.4或0.6g/d,分别于治疗前及治疗3、6、9周采集骨髓涂片,常规糖原(PAS)染色,并分析骨髓细胞形态学变化.结果 治疗过程中,多数患者骨髓细胞增生度降低较明显,粒系及原始细胞比例下降,但红系比例增高明显,巨核细胞3周时下降明显;少数患者除了红系仍呈明显增高趋势外,其余上述特征变化不明显,按照诊断标准评价骨髓,可使约1/3患者病情评价出现误差.对外周血白细胞及血小板下降显著的患者,若骨髓粒系、巨核细胞显著降低,则暂时减量或停止格列卫治疗.结论 进展期CML应用格列卫治疗初期骨髓形态学具有特征性的变化,可用于评价病情变化及指导治疗.

Morphological evaluation of bone marrow during initial stage of Gleevec therapy for treatment of chronic myelogenous leukemia

Objective To morphologically evaluate the bone marrow (BM) smear specimens collected from the patients with chronic myelogenous leukaemia (CML) in accelerated phase and blastic phase receiving a short term Gleevec therapy, and to determine its clinical significance in evaluating the changes in disease condition to guide the treatment. Methods Sequential BM smear specimens of 16 Ph positive CML patients, including 9 in accelerated-phase and 7 in blastic-phase, were examined before and 3,6 and 9 weeks after Gleevec treatment (0.4/d or 0.6g/d, PO) with routine method. Periodic acid-Schiff reagent (PAS) staining was performed for a proper identification of abnormal erythroid precursor cells. Results The treatment rapidly caused following conspicuous BM changes in the process: both cellular proliferation and neutrophil granulopoiesis decreased significantly, while the accumulation of erythroid precursor cells increased obviously, and megakaryocytes decreased markedly at 3rd week. A few patients showed no such changes, but an accumulations of erythroid precursor cells, leading to misdiagnosis in some one third of the patients. In 21 percent of patients, in whom no erythroid cells were found, were classified into accelerated phase and blast phase based on both WHO classification system and FAB system. In fact the increase in red system was a bone marrow response to anemia caused by Gleevec therapy. If a condition of severe cellular proliferation of BM with a lower WBC and platelets appeared, most patients could not tolerate the therapy, then it should be ceased. Conclusion Initial treatment with Gleevec therapy exerts pronounced changes in BM morphology, which can be used as a simple and effective method to evaluate the outcome of the patients.