成人急性双表型白血病的临床研究

目的 分析成人急性双表型白血病的临床、生物学特征和预后.方法 对65例成人急性双表型白血病患者,应用多色流式细胞术进行免疫分型,采用短期培养R显带技术进行染色体核型分析.治疗方案分为针对急性淋巴细胞白血病(ALL)、急性髓系白血病(AML)或二者兼顾的方案,bcr-abl阳性和(或)Ph阳性者部分加用伊马替尼.结果 ①成人急性双表型白血病占急性白血病的6.7%,男性多见,WBC≥130×109/L者占52.3%,WBC≥100×109/L者占16.9%.②以同时表达髓系和B系抗原者最常见,占81.5%,髓系和T系抗原共表达者占10.8%,髓系、B系、T系抗原共表达者占4.6%,B系和T系抗原共表达者占3.1%.③53例患者进行了染色体核型分析,正常核型者22例,占41.5%,其中3例为bcr.abl(+);异常核型者高达58.5%,涉及9、22、4、11、8、14、12号等染色体,Ph阳性或bcr-abl阳性者占32.1%.④65例患者完全缓解31例(56.4%).17例Ph阳性或bcr-abl阳性者完全缓解6例(35.3%).结论 成人急性双表型白血病高白细胞者多见,以髓系和B系抗原共表达最常见,异常核型发生率高,Ph染色体阳性者多见,治疗效果较差.

Study on the clinical characteristics of adult biphenotypic acute leukaemia

Objective To analyze the clinical and biological characteristics and prognosis of adult biphenotypic acute leukaemia(BAL). Methods Immunophenotypes were analyzed using muhieolor flow cy-tometry, karyotype analysis by short-term culture R-banding technique. The chemotherapy regimens were ac-cordingly for acute lymphoblastic leukaemia(ALL), acute myeloid leukaemia (AML) or for both ALL and AML. Patients with Ph(+)or bcr-abl(+)were treated with Imatinib. Results ①The incidence of BAL in acute leukaemias was 6.7%, with a male predominance and 52.3% of BAL patients had WBC≥30×109/L and 16.9% WBC≥100×109/L. ②Percentages of coexpression of myeloid and B lymphoid antigens were 81.5%, of myeloid and T lymphoid antigens 10.8%, of myeloid, B- and T lymphoid antigens 4.6%, and of B and T lymphoid antigens 3.1%. ③Normal and abnormal karyotypes accounted for 41.5% and 58.5%, re-spectively in 53 BAL patients with karyotype analysis. The rate of Ph(+)or bcr-abi(+)was 32.1%. ④31 (56.4%) of 65 patients achieved complete remission (CR), but CR rate was only 35.3% for Ph(+)or bcr-abl(+)cases. Conclusion ① High white blood cell count and eoexpression of myeloid/B lymphoid an-tigens are common in BAL. ②Abnormal karyotypes and Ph (+) or bcr-abl (+) often happen. ③The treat-ment outcome of BAL is poor.