急性双表型白血病的临床和实验室特征及预后分析

目的分析急性双表型白血病（BAL）的临床和实验室特征，评价急性白血病免疫双表型与治疗相关因素及临床预后的重要性。方法自2000年4月～2005年12月所有初诊的急性白血病患者400例，采用MICM分型，用流式细胞仪进行免疫表型分析，根据EGIL标准诊断BAL共30例。结果BAL占同期急性自血病（AL）7．5％，30例BAL临床表现与同期诊断为急性髓细胞白血病（AML）和急性淋巴细胞白血病（ALL）患者差异无显著性（P〉0．05），P170表达阳性率62％，CD34阳性率73．3％，均高于同期非BAL（P〈0．05），其中B—Ly＋／My＋双表型18例，T—Ly＋／My＋双表型10例，同时表达T抗原和B抗原2例。进行20例染色体核型分析中，异常核型占11例（55％），高于同期非BAL（P〈0．01），28例BAL患者接受治疗后完全缓解（CR）率为35，7％，1年总生存率为10．7%，9例兼顾粒、淋二系的方案治疗后全部CR，平均无病生存期（DFS）7个月。结论与同期非BAL相比，BAL的治疗效果较差、生存期短，与其较多的不良预后因素有关，对BAL治疗应兼顾粒、淋二系的诱导和巩固化疗方案，但长期疗效的评价有待临床进一步观察。

Analysis of the Clinical and Laboratory Features and the Prognosis of Biphenotypic Acute Leukemia

Objective To analyze the clinical and laboratory features of biphenotypic acute leukemia（BAL）,and assess the clinical significance between the bi-immunophenotypic leukemia and associate＋therapeutic factors as well as prognosis. Methods From April 2000 to December 2005,400 cases of acute leukemia （AL） were newly diagnosed with morphological ,immunological ,cytogenetic classification and molecular biology（MICM）. Immunophenotypes were all examined by flow cytometry, 30 cases of BAL were diagnosed according to EGIL scoring system. Result BAL was 7.5% in AL. There was no significant difference at clinical presentation between thirty BAL patients and the cases of AML/ALL during the same period（P〉0. 05）. P170 and CD34 were expressed in 62.0% and 73.3% of the BAL cases ,respectively. BAL had significantly higher expression rates of CD34 and P170 than those of non-biphenotypic cases observed （P〈0.05）. Of the thirty patients whose immunophenotypes were examined, 18 were B-Ly ＋/My ＋ phenotypes, 10 were T-Ly ＋/My ＋ phenotype and 2 were T＋B-Ly＋ phenotypes. Of the twenty BAL cases whose chromosomes were analyzed, 11 patients of abnormal chromosome were expressed in 55% of the BAL cases （P〈0.01）. In the 28 cases treated, the complete remissiom （CR） rate was 35.7% ,one year overall survival（OS） rate was 10. 7%. 9 cases all reached CR with the regimen involved both myeloid and lymphoid lineage. The disease free survival（DFS） was 7-month. Conclusion BAL had a poor treatment outcome and short survival. It had an increased frequence of poor prognostic factors compared with those of non- biphenotypic cases. Modality of chemotherapy for BAL should give attention to both ALL and AML. Further study is needed to value the longterm prognosis of BAL.