伴有淋系抗原表达的急性髓系细胞白血病亚型特征

伴有淋系抗原表达的急性髓系细胞白血病（Ｌｙ＋ＡＭＬ）,发病率各地报道不一,在急性白血病中所占的比例为０５％～２８６％［１,２］,目前国内外学者对此类急性白血病（ＡＬ）尚无一致的认识,部分学者认为是一组预后较好的ＡＬ亚型（尤其是在儿童）,而大部分学...     

急性髓系白血病H—ras表达和点突变—流式细胞术和聚合酶链反 …

目的：了解髓系白血病细胞Ｈ－ｒａｓ Ｐ＾２１表达与点突变的相关性，以及免疫组化法的临床实用价值。方法：用流式细胞术（ＦＣＭ）分析６７例初治急性髓系白血病（ＡＭＬ）Ｈ－ｒａｓ Ｐ＾２１表达；对所有Ｐ＾２１阳性和部分Ｐ＾２１阴性者作聚合酶链反应（ＰＣＲ），观察Ｈ－ｒａｓ１５位密码子点突变。结果：６７例ＡＭＬ ＦＣＭ Ｐ＾２１阳性者４５例（６７．２％），Ｐ＾２１阴性者２２例（３２．８％）。Ｐ＾２１阳性４     

过氧化物酶染色阴性的急性非淋巴细胞白血病免疫诊断特点及其临…

作者报道一组急性白血病过氧化物酶染色阴性而无淋系相关抗原表达，但与一种以上髓系相关ＭｏＡｂ反应的ＰＯＸ阴性急性非淋巴细胞白血病患者的免疫学特征。此组患者较同期化疗的急性淋巴细胞白血病、ＰＯＸ（＋）ＡＮＬＬ反应差（Ｐ＜０．０１），病程短（Ｐ＜０．０２），提示ＰＯＸ（－）ＡＮＬＬ应按难治性急性白血病处理。     

过氧化物酶染色阴性的急性非淋巴细胞白血病免疫诊断特点及其临床意义

作者报道一组急性白血病过氧化物酶（ＰＯＸ）染色阴性而无淋系相关抗原表达，但与一种以上髓系相关ＭｏＡｂ反应的ＰＯＸ阴性型急性非淋巴细胞白血病（ＡＮＬＬ）患者的免疫学特征。此组患者较同期化疗的急性淋巴细胞白血病（ＡＬＬ）、ＰＯＸ（＋）ＡＮＬＬ反应差（Ｐ＜０．０１），病程短（Ｐ＜０．０２），提示ＰＯＸ（－）ＡＮＬＬ应按难治性急性白血病处理。     

急性白血病免疫分型中的少见类型多系表达及"裸型"分析

目的：研究急性白血病（ＡＬ）细胞抗原表达特征及临床意义。方法：选用１４～１６ 种单克隆抗体,采用免疫荧光的方法,对９６例ＡＬ患者进行免疫分型。结果：９ 例为多系表达,即同时表达三系以上的抗原（急性髓细胞白血病－ＡＭＬ７ 例,急性淋巴细胞白血病－ＡＬＬ２ 例）,ＡＭＬ中多系表达发生率为１０．８％ ,ＡＬＬ中为６．５％ 。“裸细胞”型的发生率ＡＭＬ中７．７％ ,ＡＬＬ中６．４％ 。结论：呈多系表达的ＡＭＬ多为Ｍ５ 型,ＣＤ１４高表达,Ｐ－１７０ 高表达,ＣＲ率低;ＡＬＬ则发生于复发的病人     

急性混合细胞白血病的分化抗原表达及其临床特点

急性混合细胞白血病（ＡＭＬ）是指骨髓中同时或先后有淋系和髓系特征的急性白血病。由于ＡＭＬ细胞异质性明显与抗原表达复杂多变,国内外尚未有统一的ＡＭＬ诊断标准等缘故,因此,对ＡＭＬ病例极易误诊。随着白血病免疫分型的广泛开展与研究的不断深入,人们对白血病细...     

急性白血病P16基因的研究

目的：研究Ｐ１６抑癌基因在急性白血病中的变化。方法：用ＡＢＣ法研究了６１例急性白血病细胞表面Ｐ１６抗原的多表达多重ＰＣＲ法，研究了５１例急性白血病Ｐ１６基因的结构缺陷。结果：发现白血病患者Ｐ１６抗原的表达明显低于正常人（Ｐ〈０．００１），其中急性淋巴细胞白血病（ＡＬＬ）又明显低于急性髓系白血病（ＡＭＬ）（Ｐ〈０．０５）；３０例ＡＬＬ中仅发现４例Ｐ１６基因第二外显子纯合子缺失，２１例ＡＭＬ未发现Ｐ１     

抗原表达异常的急性髓细胞性白血病临床研究

急性髓细胞性白血病（ＡＭＬ）是造血系统的恶性克隆性疾病，该类疾病在病因学、致病机制及预后等方面都表现出了高度异质性。随着单克隆抗体（ＭｃＡｂ）在急性白血病（ＡＬ）的临床分型诊断及预后因素探讨中的广泛应用，越来越多的资料表明，系列分化抗原在ＡＬ中交叉表达较多，２０％～５０％的ＡＭＬ患者表达有淋系分化抗原［１］。本研究通过对１４２例初诊ＡＭＬ患者进行免疫表型检测，旨在探讨淋系分化抗原和ＣＤ３４抗原在ＡＭＬ中的预后意义。一、资料与方法１－病例：１４２例ＡＭＬ均为我院１９９５～１９９８年初治患者。按ＦＡ…     

CD7阳性急性髓细胞白血病免疫表型及临床特点

随着系列单克隆抗体的应用，白血病细胞免疫分型的广泛开展及其研究的深入，伴有ＣＤ７抗原表达的急性髓细胞白血病（ＣＤ＋７ＡＭＬ）不断被发现。有学者认为ＣＤ＋７ＡＭＬ是一类独特的急性髓细胞白血病亚型，具有与不伴有ＣＤ７抗原表达的急性髓细胞白血病（ＣＤ－７Ａ...     

CD34抗原阳性急性非淋巴细胞白血病的临床及免疫表型特征

采用免疫荧光法检测了４３例原发性急性非淋巴细胞白血病（ＡＮＬＬ）细胞ＣＤ３４抗原及其他免疫学标记的表达，其中１３例（３０．２％）表达ＣＤ３４抗原。ＣＤ３４￣（＋）ＡＮＬＬ组在年龄、血红蛋白、白细胞、血小板、外周血和骨髓原始、幼稚细胞比例等方面与ＣＤ３４￣（－）组相比较无显著差别，但表达ＣＤ３４抗原的ＡＮＬＬ多发生在男性患者，常伴有ＨＬＡ－ＤＲ（ＤＰ）、ＣＤ３８、ＣＤ７等不成熟细胞表面标记的表达，而较成熟的髓系细胞表面标记ＣＤ１５则不表达。ＣＤ３４￣（＋）ＡＮＬＬ与ＦＡＢ亚型Ｍ１、Ｍ５ａ有着密切的关系，且对化疗反应较差，证明ＣＤ３４￣（＋）ＡＮＬＬ是一组分化程度较差的类型。     

Characterization of childhood acute leukemia with multiple myeloid and lymphoid markers at diagnosis and at relapse

To define the clinical and biologic significance of childhood acute mixed-lineage leukemia diagnosed by stringent criteria, we studied 25 cases of acute lymphoblastic leukemia expressing greater than or equal to 2 myeloid-associated antigens (My+ ALL), and 16 cases of acute myeloid leukemia expressing greater than or equal to 2 lymphoid associated antigens (Ly+ AML). These cases represented 6.1% of 410 newly diagnosed ALLs (two treatment protocols) and 16.8% of 95 AMLs (two protocols). T-lineage--associated antigens were identified in 9 of the My+ ALL cases and in 14 of those classified as Ly+ AML; all but 1 of the 19 cases that could be subclassified had an early thymocyte stage of differentiation. The My+ ALL cases had an increased frequency of French-American-British (FAB) L2 morphology (36%); the Ly+ AML cases were characterized by FAB M1 or M2 morphology, low levels of myeloperoxidase reactivity and combined populations of myeloperoxidase-positive large blasts and small blasts generally of hand-mirror morphology. Karyotypic abnormalities included t(9;22)(q34;q11) in three cases of My+ ALL, 11q23 translocations in two cases of My+ ALL, and 14q32 translocations in three My+ ALL and five Ly+ AML cases. Mixed-lineage expression lacked prognostic significance in either ALL or AML; however, the findings indicate that some patients with Ly+ AML may respond to prednisone, vincristine, and L-asparaginase after failing on protocols for myeloid leukemia. At relapse, two My+ ALLs had converted to AML and two Ly+ AMLs to ALL; one case in each group showed complete replacement of the original karyotype. Acute mixed-lineage leukemia does not adequately describe the heterogeneity of the cases identified in this study and should be replaced by a set of more restrictive terms that indicate the unique biologic features of these leukemias.     

交叉表达淋系和髓系相关抗原的急性白血病的生物学及临床特征研究

目的：探讨交叉表达淋系和髓系相关抗原的急性白血病患者的生物学与临床特征及预后。方法：用流式细胞术检测白血病细胞的免疫表型，根据FAB亚型和免疫标记将病例分为6组；CD7表达阳性的急性髓细胞性白血病（CD7^ AML）、CD7表达阴性的伴淋系相关抗原的急性髓细胞性白血病（CD7^-Ly^ AML）、不伴淋系相关抗原的急性髓细胞性白血病（Ly^-AML）、伴髓系相关抗原的急性淋巴细胞性白血病（My^ ALL）、不伴髓系相关抗原的急性淋巴细胞性白血病（My^-ALL）和急性杂翕生白血病（HAL）。结果：CD7^ AML组的白细胞数高于Ly^-AML组及CD7^-Ly^ AML组，诱导缓解率（16.7％）低于Ly^-AML组（71.4％），有显著差异；CD7^-Ly^ AML组与Ly^-AML组分别比较，发病年龄较高，白细胞数较高，贫血较明显，平均缓解期及平均生存期较短。结论：CD7^ AML及CD7^-Ly^ AML具有不同的临床特征，预后较差，可以看作一个独特的临床亚型。HAL与My^ ALL相比较，具有不同的临床特征，应该区别对待。     

Two Cases of Secondary Acute Myeloid Leukemia Accompanying Adult T-Cell Leukemia/Lymphoma

We identified 2 cases of secondary acute myeloid leukemia (AML) following adult T-cell leukemia/lymphoma (ATL) in patients who had previously received chemotherapy. Both cases were thought to represent therapy-related AML because the patients had previously received combination chemotherapy including epipodophyllotoxin, anthracycline, and alkylating agents for the ATL. The cases were diagnosed as AML M4 with eosinophilia and AML M2, with the chromosomal abnormalities inv(16)(p13q22) and t(8;21)(q22;q22), respectively. In our hospital, only these 2 cases of secondary AML accompanying ATL were identified among 90 cases of acute- or lymphoma-type ATL diagnosed from October 1999 to July 2006. The frequency of coexisting AML and ATL is lower than that reported for acute leukemia coexisting with other lymphoid malignancies. The low frequency of secondary leukemia with ATL may be associated with the short survival times of ATL patients.     

Low proportion of G0-phase cells during induction chemotherapy correlates with subsequent remission in acute myeloid leukemia

Kinetic resistance is assumed to be one of the main mechanisms of drug resistance in acute myeloid leukemia (AML), but the relationship between cell cycle status at diagnosis and achievement of complete remission (CR) is controversial. Based on the possibility that the cell cycle data after starting induction chemotherapy are more important than the pretreatment data, we used 3-color flow cytometry to examine the cell cycle (G0, G1, S, and G2/M phases) of AML cells on days 0, 5, and 9 of the first induction chemotherapy in 20 patients. Cell cycle data at these 3 time points were compared in the patients who achieved CR (CR cases) and in the patients who had persistent leukemia (non-CR cases) after the induction chemotherapy. In the CR cases, there was a tendency for the percentages of G0-phase AML cells on days 5 and 9 to be smaller than that on day 0, while the opposite tendency was observed in the non-CR cases. When cell cycle data were compared between the CR and non-CR cases, the percentage of G0-phase AML cells on day 9 differed significantly (CR cases 6.9% +/- 10.9%, non-CR cases 50.1% +/- 38.4%; P = .0024). This significance remained when the patients' AML subtype was taken into consideration. None of the other cell cycle data at each time point or the hematologic parameters, which may be related to CR achievement, showed differences between the CR and non-CR cases. We emphasize the importance of cell cycle analysis after initiating therapy and suggest that such analysis can identify refractory AML subjects. The identified subjects may be candidates for clinical trials of cell cycle modulators.     

Clinical results and issues of acute myeloid leukemia in elderly patients aged 75 years and older

Aim: Clinical outcomes of acute myeloid leukemia (AML) in elderly patients still remain unsatisfactory and the optimal treatment has yet to be clearly established. This report describes the results of a retrospective study of clinical outcomes and prognostic factors of AML in patients aged 75 years and older. In addition, we aimed to elucidate the situation of patients with AML accompanied by dementia, which has been largely ignored in previous studies. Methods: The subjects consisted of 31 patients with untreated AML (including previous myelodysplastic syndrome: AML/MDS). All patients underwent chemotherapy, with 25 undergoing conventional therapy and six undergoing low‐intensity therapy. Results: Complete remission was obtained in 16 of the 31 cases (51.6%), with a 3‐year survival rate of 11.5%. However, in seven cases, Alzheimer's disease (AD) was observed. Although we were able to perform induction therapy in each of these cases, consolidation therapy was difficult in cases of moderate AD. Conclusion: The results of this study suggest that even very elderly patients can benefit from chemotherapy. However, it is thought that the treatment selection for cases which are complicated by moderate to severe dementia should be determined carefully while considering the patient's quality of life. Geriatr Gerontol Int 2011; 11: 290–296 .     

Acute myeloid leukaemia in childhood: clinical features and prognosis

Clinical and laboratory features at presentation were correlated with morphological (FAB) subclass of AML in a group of 112 children diagnosed between 1972 and 1982. Patients with a monocytic component of AML (M4, M5) had higher initial leucocyte counts, a higher incidence of extramedullary infiltration and of CNS involvement. In M4 AML CNS relapse occurred in patients with a high initial leucocyte count whereas in M5 AML CNS involvement tended to occur at presentation in children with low initial counts. Two-thirds of patients treated achieved remission and most failures were due to inadequate chemotherapy, although haemorrhage, leucostasis or metabolic complications caused early death in patients with M4 and M5 AML. With a minimum follow up of 3 years only 12% of patients are alive; these figures have not improved in consecutive series despite increasing intensity of induction and more recent availability of bone marrow transplantation. No features predictive of long-term survival were identified, but patients with myeloid differentiation (M1, M2, M3) did better than those with a monocytic or erythroid component (M4, M5, M6). The proportion of patients with AML curable by chemotherapy seems unlikely to increase without marked intensification of post-remission chemotherapy. More aggressive CNS prophylaxis may be of benefit in cases with a monocytic component.     

Acute myeloid leukemia secondary to a myelodysplastic syndrome with t(3;3) (q21;q26) in an HIV patient treated with chemotherapy and highly active antiretroviral therapy

We describe the first case of secondary acute myeloid leukemia (AML) with t(3;3) (q21;q26) occurring in a human immunodeficiency virus (HIV)-infected patient sequentially treated with chemotherapy and highly active antiretroviral therapy (HAART). The t(3;3) is a nonrandom abnormality found in a small percentage of patients with myelodysplastic syndrome, secondary AML or chronic myeloid leukemia and is strongly associated with abnormal thrombopoiesis and a particularly poor prognosis. So far, it has never been observed in HIV-positive patients. Sporadic cases of AML have been reported in HIV patients and the feasibility of chemotherapy in association with HAART and disease outcome are still not clearly defined. Despite the poor response to chemotherapy in our case, which might also be related to the unfavorable karyotype, the secondary nature of the disease and the HIV positivity, the patient had a relatively long period of survival that could be due to the use of HAART. The association of chemotherapy with HAART appeared to be feasible and tolerable and could be suggested as a choice treatment in this peculiar subset of HIV/AML patients.     

Therapy-related acute lymphoblastic leukaemia with MLL rearrangements following DNA topoisomerase II inhibitors, an increasing problem: report on two new cases and review of the literature since 1992

A highly increased risk of myelodysplasia (MDS) and acute myeloid leukaemia (AML) is well established in patients previously treated for other malignancies with alkylating agents or topoisomerase II inhibitors. More recently, single cases of acute lymphoblastic leukaemia (ALL), often presenting balanced translocations involving chromosome band 11q23, have been observed. We present two such cases with t(4;11)(q21;q23), one of whom had previously received only single-agent chemotherapy with 4-epi-doxorubicin. A review of the literature since 1992 including these two patients reveals a total of 23 cases of ALL or lymphoblastic lymphoma after chemotherapy presenting balanced translocations to 11q23. All 23 patients had previously received at least one topoisomerase II inhibitor, and in two patients 4-epi-doxorubicin had been administered as single-agent chemotherapy for breast cancer. The latency period to development of t-ALL was 24 months or less in 20 out of 22 cases. The MLL gene was found to be rearranged in 14 out of 14 cases, and in three out of six cases the breakpoint was at the telomeric part of the gene, as observed in most cases of AML following therapy with topoisomerase II inhibitors. These results indicate that patients with ALL and balanced translocations to chromosome band 11q23 following chemotherapy with topoisomerase II inhibitors in the future should be included with cases of MDS or AML in calculations of risk of leukaemia.     

Outcome of acute myelogenous leukemia in 41 patients treated with idarubicin: the prognosis of t(8;21) cases

Idarubicin (IDR) has been used as the main drug in induction chemotherapy for acute myelogenous leukemia (AML) in the USA and Europe. Between May 1995 and October 1998, we treated 41 cases of fresh AML using IDR induction chemotherapy and analyzed the clinical course, remission rate, relapse rate and prognosis. The results obtained in these cases were similar to those in 26 cases treated with daunorubicin (DNR) in our hospital according to JALSG-AML92. The outcome in cases with abnormal chromosomes and cases showing relapse was very poor. In particular, all 5 t(8;21) cases in our series relapsed, suggesting that t(8;21) cannot be considered a favorable prognostic factor in cases treated with IDR-containing regimens. However, 3 of the 5 t(8;21) cases were positive for CD56, which itself is an unfavorable prognostic factor. Thus it is possible that CD56 was related to the poor outcome. Intensive post-remission induction chemotherapies will be required in order to obtain prolonged disease-free survival.     

Bone Marrow MicroRNA-335 Level Predicts the Chemotherapy Response and Prognosis of Adult Acute Myeloid Leukemia

The aim of this study was to investigate the role of microRNA-335 (miR-335) in determining the treatment response and prognosis in adult acute myeloid leukemia (AML) patients receiving the cytarabine (Ara-C)-based chemotherapy.A total of 204 adult AML patients were collected. The miR-335 levels in serum and bone marrow samples from these patients were determined. All patients received Ara-C-based standard induction chemotherapy regimens. The treatment response to Ara-C-based chemotherapy was evaluated. All patients were followed for prognostic analyses.The levels of miR-335 in bone marrow and serum samples from adult AML patients achieving complete response were significantly higher than those without. The serum miR-335 level was not associated with the chemotherapy response and prognosis in these AML patients. In contrast, high bone marrow miR-335 level was significantly associated with a poor treatment response and also predicted a worse prognosis indicated by the relapse-free survival and overall survival periods in adult AML patients receiving Ara-C-based chemotherapy.Our finding suggests that bone marrow miR-335 level may be used as a marker to predict the chemotherapy response and prognosis in adult AML patients.