慢性髓细胞白血病急变期形态学及免疫学和细胞遗传学特征研究  

The morphological, immunophenotypical and cytogenetic characteristics study of blast crisis in chronic myeloid leukemia

作　　者：唐晓文[1] 吴德沛[1] 薛永权[1] 朱明清[1] 陆定伟[1] 阮长耿[1] 

机构地区：[1]江苏省苏州大学附属第一医院江苏省血液研究所苏州大学核医学生物技术重点实验室,215006

出　　处：《中华内科杂志》2002年第10期685-687,共3页Chinese Journal of Internal Medicine

摘　　要：目的　探讨慢性髓细胞白血病急变期 (CML BC)的形态学、免疫表型和细胞遗传学(MIC)特征。方法　对 31例CML BC患者骨髓涂片进行形态学和细胞化学染色分析 ,采用微量全血法及流式细胞仪进行细胞免疫分型 ,细胞遗传学采用直接法或短期培养法制备染色体标本 ,采用R显带技术进行核型分析。结果　免疫分型结果显示 :急变为急性髓细胞白血病 (AML) 2 3例占 74 2 %;急性淋巴细胞白血病 (ALL) 5例占 16 1%,均为B系ALL ,其中 4例同时伴有髓系表达 ;急性未分化细胞白血病 1例 ,B系和髓系急性混合细胞白血病 (AMLL) 2例。 31例CML BC中 2 1例 (6 7 7%)的急变患者CD+ 3 4 ,其中 4 /5 (80 0 %)ALL ,15 /2 3(6 5 2 %)AML ,2 /2AMLL均为CD+ 3 4 。AML急变患者中具有CD7和CD3 4 共表达者为 8/2 3(占 34 8%)。细胞遗传学分析表明 ,14 /2 7(5 1 9%)的急变期患者出现Ph染色体以外的附加核型异常 ,其中有 +8(3/14 ) ,+Ph(3/14 ) ,i(17q) (2 /14 ) ,Y染色体丢失 (1/14 )及复杂易位 (5 /14 )。结论　CML BC是一干细胞疾病 ,原始细胞分化阻滞在早期阶段 ,故预后差。MIC分型在CML BC诊断 ,预后判断及指导治疗方面均有重要价值。Objective To explore the morphological, immunophenotypical and cytogenetic (MIC) characteristics of chronic myeloid leukemia in blast crisis (CML BC) Methods Marrow cells from 31 CML BC patients were studied by bone marrow smears with morphological and cytochemical stain analysis Immunophenotypic analysis was performed by micro blood method and flow cytometry Cytogenetic analysis was performed using bone marrow cells prepared directly and or after 24 hours culture RHG banding was used for karyotypic analysis Results 23 patients (74 2%) were found to have myeloid blast crisis 5 cases (16 1%) had a B lymphoid immunophenotype and 4 of them expressed myeloid associated antigens at the same time Another 3 cases were classified as acute undifferentiated leukemia (AUL 1 patient) and acute myeloid lymphoid leukemia (AMLL 2 patients) with B and myeloid markers expression A significant proportion (67 7%) of blast crisis cases were CD 34 positive CD 34 was expressed in 80 0%of lymphoid and 65 2% of myeloid BC Analysis of the relationship between CD 7 and CD 34 expression in blasts of myeloid crisis showed their dual expression in 8/23 (34 8%) of the cases Cytogenetic analysis indicated that 14/27(51 9%) of the patients had developed secondary cytogenetic abnormalities in addition to the Ph chromosome These newly emerging abnormalities included a trisomy 8 in 3 patients, a double Ph chromosome in 3 patients, an iso chromosome 17q in 2 patients, loss of Y chromosome in 1 patent and other complicated translocation in 5 patients Conclusion Blast crisis of CML is a kind of disease of stem cell The differentiation of blast cell is blocked in the early stage The prognosis of such patients is poor MIC showed its important values in diagnosis, judgement of prognosis and determination of therapeutic protocol of CML BC

关 键 词：慢性髓细胞白血病 急变期 形态学 免疫学 细胞遗传学 

分 类 号：R733.72[医药卫生—肿瘤]