急性混合细胞白血病实验室特征与临床相关性研究

目的探讨急性混合细胞白血病(HAL)的实验室特征及其与诊断分型和临床治疗的相关性.方法对27例HAL住院患者的临床及实验资料进行回顾性分析.结果HAL患者临床上易合并肝、脾、淋巴结肿大及各种浸润症状.外周白细胞数高,易合并重度贫血.免疫表型中双系列较双表型多见.诱导缓解治疗缓解率为25.0%.以兼顾急性淋巴细胞白血病(ALL)和急性非淋巴细胞白血病(AML)方案及针对ALL的方案缓解率高.形态学表现为髓系白血病,合并重度贫血者以及有细胞遗传学异常者化疗缓解率低;而免疫表型、外周血白细胞数、血小板是否正常、是否合并浸润症状对化疗有效率无影响.化疗后易合并肺部细菌和霉菌混合感染,预后差.结论HAL病情凶险,临床有一定特点,但诊断应进行以免疫表型为主的MICM分型.形态学表现为髓系白血病,合并重度贫血者以及有细胞遗传学异常者诱导缓解治疗效果不佳.治疗应首选兼顾ALL和AML的方案或针对ALL的方案.

The Correlation between Clinic and Laboratory Characteristics of Acute Mixed Leukemia

Objective To explore the relationship among the laboratory characteristics, diagnostic classification and clinical treatment in acute mixed leukemia (HAL). Methods The clinical and laboratory data of 27 HAL patients were retrospectively analyzed. Results HLA always complicated hepatauxe, splenomegaly, adenophyma and various invasion syndromes in clinic. Leukocyte in peripheral blood of patients often increased and severe anemia was also common. Among immunophenotypes of HAL, two series subtype was more than the biphenotypic one. The overall complete remission (CR) rate was 25 0%. The protocols both considering acute lymphocytic leukemia (ALL) and acute myeloid leukemia (AML) or mainly aiming at ALL were effective. Clinical effect of those patients, who were AML, combined with severe anemia and abnormalities in cytogenetics, was not ideal. However, immunophenotype, leukocyte count, platelet and combination with invasion syndrome had no influence on effective rate of chemical therapy. Conclusions Clinical presentation of HAL is severe, and immunophenotype should be classified during the diagnostic process. The treatment aimed at either ALL and AML or that just for ALL is preferred.