急性混合细胞白血病诊断及疗效的临床研究  

Diagnosis and therapeutic outcome of acute mixed lineage leukemia

作　　者：张诚[1] 陈幸华[1] 张曦[1] 高蕾[1] 彭贤贵[1] 孔佩艳[1] 刘思恒[1] 刘红[1] 王武[1] 王庆余[1] 

机构地区：[1]第三军医大学新桥医院血液内科,重庆400037

出　　处：《第三军医大学学报》2007年第19期1896-1899,共4页Journal of Third Military Medical University

基　　金：重庆市医学重点学科建设基金(2006);第三军医大学新桥医院"1520人才培养工程"专项基金(2006)~~

摘　　要：目的探索急性混合细胞白血病(acute mixed lineage leukemia,AMLL)的临床和实验室特征以及疗效和预后。方法根据骨髓细胞形态学、化学染色和免疫表型结果诊断AMLL,评价疗效及影响疗效的有关因素。结果AMLL可有发热、贫血、淋巴结肿大、肝脾肿大等临床表现。半数患者属高白细胞白血病。所有患者骨髓增生明显活跃,原始+幼稚细胞占0.86(0.79～0.96)。8例患者免疫表型均为B-Ly/My+。兼顾粒、淋二系的方案诱导化疗的7例AMLL中,6例首次完全缓解(CR1),1例发生诱导化疗有关死亡,完全缓解后坚持巩固强化治疗的3例患者,已平均无病生存7(5～9)个月。结论AMLL属特殊类型的白血病,其诊断有赖于对细胞形态学、化学染色和免疫分型的综合判断。对AMLL的治疗应予兼顾粒、淋二系的诱导和巩固化疗方案,缓解率较高,但长期疗效的评价还有待进一步观察。Objective To investigate the clinical and laboratorial features of acute mixed lineage leukemia （AMLL）, as well as its chemotherapeutic and effect prognosis. Methods AMLL was diagnosed according to the findings of morphology, cytochemistry and the immunophenotype of bone marrow ceils. Therapeutic outcome was evaluated and the relative factors were analyzed. Results Clinical presentations of 8 AMLL patients included fever, enlargement of the lymph nodes, spleen and/or liver. Half patients belonged to hyper-leukocytic leukemia. The marrows of all the patients were markedly hypercellular with leukemic ceils accounting for 0.86 （0.79 - 0.96）. The immunophenotypes of 8 patients were all B-Ly/My ^＋ phenotype. Seven of the 8 patients received the induction chemotherapy with the regimen targeting both myeloid and lymphoid lineage, in whom 6 patients were completely remitted, and 1 patient died of induction chemotherapy-related death. Three of the 6 patients were continually given chemotherapy and the duration of disease-free survival has reached to 7 months （ranging from 5 to 9 months）. Gonclusion AMLL, a specific leukemia, should be diagnozed on the overall analysis of cell morphology, cytochemistry and immunophenotype. Modality of chemotherapy for AMLL should aim at both acute lymphoid leukemia and acute nonlymphocytic leukemia. Further study is needed to elucidate the long-term prognosis of AMLL.

关 键 词：急性混合细胞白血病 免疫分型 预后 诊断 

分 类 号：R446.1[医药卫生—诊断学] R733.7[医药卫生—临床医学]