上海地区805例成人急性白血病世界卫生组织亚型的临床分析

目的 分析上海地区24家医院急性白血病(AL)世界卫生组织(WHO)亚型的分布,并与国外资料进行比较,探讨我国AL患者WHO亚型的分布特点.方法 收集连续样本,对中美联合上海市白血病协作组805例AL患者同时采用FAB和WHO分型标准进行分型诊断.结果 本组AL中急性髓系白血病(AML)77.4%(623/805),急性淋巴细胞白血病(ALL)20.4%(164/805),AML和ALL之比为3.8:1.伴有重现性细胞遗传学异常AML占36.4%,AML伴多系病态造血占17.7%,不属于上述分类的AML占45.9%.FAB分型中M4最多,占33.9%,M3和M4比例高于国外,M1比例低于国外报道.与上海市1984-1994年AL资料相比,M4亚型比例增多,M1和M5亚型比例减少.AML染色体异常率61.7%,AML伴t(15;17)比例高于国外,染色体预后良好组占30.1%,预后中等组占51.6%,预后不良组占18.3%,预后良好组比例高于国外.ALL中前体B细胞ALL占绝大多数(82.3%),ALL中t(9;22)占28.2%.结论 AML伴t(15;17)和M4比例高于国外,染色体预后良好组比例高于国外,AML的WHO分型和染色体异常类型与国外有所不同.与上海市1984-1994年AL资料相比,AML的亚型分布有所变化.

A clinical study of 805 adult acute leukemia patients in Shanghai according to WHO classification

Objective To evaluate WHO classification of acute leukemia (AL) in Shanghai and compare the difference between WHO and FAB classification as well as to comprehend the subtype difference between Chinese and the Western patients. Methods Successive and unselected adult AL patients were referred to Sino-US Shanghai Leukemia Cooperative Group from 2003 to 2007. A total of 805 patients with adult AL were diagnosed and classified according to WHO and FAB classification. Results Of the 805 adult AL patients, 623 (77.4%) were diagnosed as acute myeloid leukemia (AML) and 164 (20.4%) acute lymphoblastic leukemia (ALL). The AML and ALL percentage ratio was 3.8:1. AML with recurrent cytogenetic abnormalities accounted for 36.4%, with multilineage dysplasia for 17.7% and AML with not otherwise categorized for 45.9%. According to FAB classification, AML-M4 was the most (33.9%)common subtype. The percentage of AML-M3 and M4 in China was higher than that in the Western, but that of AML-M1 was lower. Comparing with the AL data of Shanghai Leukemia Group between 1984 and 1994,the percentage of AML-M4 was increased, but that of AML-M1 and M5 were decreased. The incidence of karyotypic abnormalities of AML was 61.7%. The incidence of AML with t( 15 ; 17 ) was higher than that in the Western. Cytogenetic favorable group accounted for 30. 1%, intermediate group for 51.6% and unfavorable group for 18. 3% of AML. B-ALL was the majority (82.3% ) in ALL. ALL with t(9;22) was 28.2%. Conclusions The percentage of AML with t(15;17) and AML-M4 and the incidence of cytogenetic favorable group in China were higher than those in the Western. These is difference in WHO classification and karyotypic abnormalities of AML between China and the Western. Comparing with the AL data of Shanghai between 1984 and 1994, some subtypes of FAB classification were changed.