急性双表型白血病的临床及生物学特征研究

目的分析急性双表型白血病（BAL）的临床、生物学特征及治疗疗效。方法对40例急性双表型白血病患者的临床和实验室资料,应用流式细胞术进行免疫分析,采用直接培养法或24/48h短期培养法G显带技术检测染色体。应用兼顾髓系和淋系的V（M）DALP方案联合化疗,Ph阳性患者部分加用伊马替尼治疗。结果符合急性双表型白血病诊断的40例,其中男26例,女14例,发病时WBC≥30×10^9/L者20例（50.0%）,WBC≥100×10^9/L者6例（15.0%）,合并肝、脾肿大者16例（40.0%）,2例患者（5.0%）合并中枢神经系统白血病;以同时表达髓系和B系抗原者最常见,占72.5%,髓系和T系抗原共同表达者占25.0%,B系和T系抗原共同表达者占2.5%。急性双表型白血病患者中CD34阳性高表达占80.0%;对30例患者进行了染色体核型分析,正常核型者13例,占43.3%,异常核型者17例,占56.7%,其中9例（30.0%）Ph染色体阳性表达;40例患者完全缓解19例（47.5%）,9例Ph染色体阳性患者完全缓解3例（33.3%）。结论急性双表型白血病高白细胞者多见,以表达髓系和B系抗原共表达者最常见,异常核型发生率高,Ph染色体阳性者多见,治疗效果较差,预后不良。

Study on the clinical characteristics of biphenotypic acute leukemia identified

Objective To analyze the clinical and biological characteristics and prognosis of biphenotypic acute leukemia（BAL）.Methods Immunophenotypes were analyzed using multicolor flow cytometry,karyotype analysis by short-term culture G-banding technique.The chemotherapy regimens were accordingly for both acute lyphoblastic leukaemia（ALL）,acute myeloid leukaemia（AML）.Patients with Ph（＋）were treated with Imatinib.Results 50.0% of the BAL patients had WBC ≥30×109/L and 15.0% WBC≥100×109/L,Percentages of coexpression of myeloid and B lymphoid antigens were 72.5%,of myeloid and T lymphoid antigens 25.0%,and of B and T lymphoid antigens was 2.5%.The rate of CD34 antigen expression was 80.0% in BAL.Normaland abnormal karyotypes accounted for 43.3%and 56.7%,respectively in 40 BAL patients with karyotype analysis.The rate of Ph（＋）was 25.0%.19（47.5%）of 40 patients achieved complete remission（CR）,but CR rate was only 33.3% for Ph（＋）cases.Conclusion High white blood cell count and coexpression of myeloid and B lymphoid antigens are common in BAL.Abnormal karyotype and Ph（＋）often happen.The treatment outcome of BAL is poor.