【摘要】 目的 分析交叉抗原表达的急性白血病的临床特征及缓解率。 方法 对2009年10月-2010年11月血液内科的210例交叉表达髓系和淋巴细胞系相关抗原的初治急性白血病患者的标本，采用流式细胞术检测白血病细胞的免疫表型，根据免疫标记和FAB（French、American、Britain）分型进行分组，分析其异质性的生物学特征和影响缓解率的相关因素。 结果 210例急性白血病的FAB分型以AML-M1/M2（82例）和ALL（78例）为主；免疫分型以B淋巴细胞系和髓系混合表达多见（116例），其中CD34表达率高达91.4%（192例）， CD7表达率为50.5%（106例），且与CD34相关（P=0.04）；出现CD34、CD7、CD19三者共表达的患者缓解率较低（9.09%）。 结论 交叉抗原表达的急性白血病的诊断有赖于免疫分型的判断，其分化抗原的表达类型是影响其缓解率的重要因素。【Abstract】 Objective To observe the clinical characters of acute leukemia with cross-lineage antigen expression and analyze the remission rate. Methods Between October 2009 and November 2010, 210 patients were diagnosed and classified by morphology. Cytochemistry and immunology were used to analyze the immunophenotype. According to the immunostaining relative factors and FAB (French, American, and Britain) phenotype standard, the samples were divided into several groups. The conical characters and relative factors of remission rate were analyzed. Results In 210 patients with cross-lineage antigen expression, AL, AML-M1/M2 (82 cases) and ALL (78 cases) were common in FAB phenotype,and cross-lineage of B lineage and myelolineage were common in immunotype (116 cases). CD34 got the highest expression frequency of all (192 cases),and had the most important effect on patients′ prognosis. CD7 was also positive commonly (106 cases) and related with CD34 (P=0.04). So it′s significant for the outcome. The patients who got co-expression of CD34, CD7 and CD19 had worse prognoses. Conclusions Acute leukemia with cross-lineage antigen expression is a special type and is confirmed by immunotype. Furthermore, expression types of differentiation antigen are critical for the prognosis.
Continuous activation of Janus kinase (JAK)- signal transduction and activator of transcription (STAT) signaling pathway is prevalent in leukemia cells, and it has been found that this pathway plays an important role in acute leukemia (AL). JAK2/JAK1 gene mutations are found in both acute myelocytic leukemia and acute lymphoblastic leukemia and may have implications for the treatment and overall prognosis of the disease. Among the STAT family members, STAT3 and STAT5 proved to be key factors in AL. These gene mutations may provide new targets and new ideas for the treatment of AL. This article provides a review of the research progress of JAK-STAT signaling pathway, related gene mutations and AL.
目的 探讨婴儿急性白血病（IAL）的临床与实验室检查特征。 方法 对1999年12月－2011年6月收治的15例婴儿急性白血病的临床资料进行总结与分析。 结果 其中急性淋巴细胞白血病（ALL）6例，急性髓系白血病（AML）8例，分类不明1例，其中以M4（4例）、M5（3例）为主。临床表现多样，髓外浸润明显。1例细胞形态学与免疫分型有差异，1例合并染色体异常。放弃治疗者11例，死亡2例，正规治疗的2例于诱导缓解后获完全缓解。 结论 IAL预后差，需完善相关检查并不断总结临床资料以提高IAL治愈率。
Objective To detect the difference between the peroxidase (POX) by cytochemical staining and cytoplasm myeloperoxidase (cMPO) by flow cytometry in acute leukemia cells, and provide a more accurate basis for the classification of leukemia. Methods The positive rate of POX in acute leukemia cells was detected by cytochemical staining. The positive rate of cMPO in acute leukemia cells was detected by flow cytometry. Then the positive rate of POX and cMPO, and the positive cells score were analyzed. Results The positive rate and the positive cells scores between POX and cMPO in acute lymphoblastic leukemia were significantly different (P<0.05), the positive rate and the positive cells scores of POX were significantly higher than those of cMPO. The positive rate between POX and cMPO in acute non-lymphoblastic leukemia (ANLL) had significant differences (P<0.05), the positive rate of cMPO was higher than that of POX; but no difference was found between POX and cMPO positive cells scores in ANLL (P>0.05). In acute myelocytic leukemia (AML)-M1 subtype, significant difference was found in the positive rate between POX and cMPO (P=0.006); cMPO positive rate was significantly higher than that of POX, but the POX positive cells score was significantly higher than that of cMPO (P=0.001). There were no significances of positive rate and positive cells score in AML-M2, AML-M3, AML-M4, AML-M5 subtypes between POX and cMPO (P>0.05). Conclusions There are not major differences between positive rate of POX and cMPO, as well as the positive cells scores in acute leukemia, especially acute myelocytic leukemia. We can choose the better method according to the actual situation and the sensitivity requirements. The two methods should be replenished by each other and used alternately.
目的 建立急性白血病（AL）患者八色流式免疫表型分析起始管方案。 方法 用胞膜CD3（CD3）、CD19、CD10、CD34、CD45、胞浆CD79a（cCD79a）、髓过氧化物酶（MPO)和胞浆CD3（cCD3）等8种抗体建立八色流式染色方案。膜表面抗体直接染色；膜内抗体经固定破膜，再染色后上机检测。将3个血小板减少患者骨髓标本分别进行抗体的单色染色和缺一色染色；最后对17例确诊的AL初发患者标本进行检测。 结果 用单色染色来确定染色方案中各抗体的检测电压及荧光补偿；缺一色染色中，阳性细胞群较单色染色变化均＜10%，表明方案中的各抗体相互作用小。17例AL初发患者中，6例急性B淋巴细胞白血病原始细胞均为CD34和CD19阳性，5例cCD79a阳性和4例CD10阳性；4例急性T淋巴细胞白血病患者均为cCD3阳性；6例急性髓细胞白血病均为CD34和MPO阳性；1例B+T混合表型AL患者CD34、cCD3、CD19、cCD79a及CD10均为阳性，MPO和CD3为阴性，此检测方案能够确定各类AL的细胞类型。 结论 建立了AL患者八色流式免疫表型分析起始管方案，操作简便快速，适用于临床检测。
目的 探讨吉西他滨+米托蒽醌+足叶乙甙（GME）方案诱导化学疗法（化疗）治疗复发难治性急性白血病的疗效。 方法 2010年5月－2011年4月对20例复发难治性急性白血病应用GME方案化疗，以了解其有效性、毒副反应。 结果 随访7个月20例复发难治性白血病经过GME方案诱导化疗1个疗程后总反应率为50%，其中5例完全缓解，4例部分缓解，1例形态学完全缓解而血细胞计数未完全缓解，均无早期死亡患者。 结论 GME方案可作为复发难治性急性髓系白血病的一种安全、有效的诱导化疗方案，值得临床尝试。
The poor treatment effect and short survival period of patients with acute leukemia are mainly due to the lack of effective early diagnosis and treatment targets. Lipid metabolism reprogramming meets the material and energy requirements for rapid proliferation and division of tumor cells, and is associated with the invasiveness, recurrence, and chemotherapy resistance of acute leukemia. This article reviews the carcinogenic and chemotherapy resistance mechanisms of lipid metabolism reprogramming in leukemia cells, and summarizes the latest findings on targeted fatty acid metabolism pathways, aiming to provide a new perspective on the role of intracellular fatty acid metabolism in the occurrence and development of acute leukemia. It is expected to provide a theoretical basis for the elucidation of its resistance mechanism and the development of corresponding targeted therapies.